微创旋切手术治疗女性多发性乳房肿块

Minimally traumatic percutaneous removal of multiple breast masses in female patients with ultrasound guidance

目的 探讨在实时超声引导、监测下微创旋切术治疗多发性乳房肿块的疗效和应用价值。方法 对 4 3例 99处 9～ 33mm多发性乳房肿块进行实时超声引导、监测下负压、手控微创旋切手术 ,肿块最大直径为 9～ 2 0mm 4 1枚 (占 4 1 4 % ) ,2 1～ 33mm 5 8枚 (占5 8 6 % )。采用 11G和 8G旋切刀旋切 ,并进行病理学检查和临床随访观察。结果 2 7例乳房多发性肿块采用 8G旋切刀进行微创旋切 ,16例采用 11G旋切刀 ,均成功地去除乳房多发性病灶 ,平均每例旋切 15次 (7～ 2 6次 ) ,术中超声监测无病灶残留 ,平均手术时间 2 0min(12～ 36min) ,伤口愈合好 ,病理学检查均提示乳腺良性病变 ,以乳腺纤维腺瘤最为常见 ,临床和超声随访检查均无复发征象 ,术后乳房外观和疗效非常满意。结论 实时超声引导和监测下的微创旋切手术能够彻底切除多发性乳房肿块 ,具有定位准确、创伤小、切口瘢痕微小、乳房外观好、临床疗效可靠等特点。这项技术是治疗女性多发性乳房肿块的一种理想。

Objective To evaluate the efficacy, safety, and patient acceptance of a vacuum-assisted, hand-held biopsy device(Mammotome) in minimally traumatic percutaneous removal of multiple breast masses in female patients under real-time ultrasound guidance. Methods Forty-three women with 99 low-risk multiple palpable masses were involved in the study. Forty-one breast lesions with the diameter between 9 and 20mm, and 58 with the diameter between 21 and 33mm, were removed by the aid of a vacuum-assisted, hand-held biopsy device with 11-gauge or 8-gauge probes. The pathological examination and follow-up evaluation were performed after the procedure. Results The imaged lesions were completely removed successfully from 27 patients and 16 patients using the 8-guage probe and 11-gauge probe, respectively. Most of the lesions were proved to be breast fibroadenoma by pathological examination. No evidence of recurrence was found by physical examination and the ultrasound evaluation during the follow-up period. Most patients were satisfied with the incision, postoperative breast appearance, and the procedure results. Conclusions Minimally traumatic percutaneous removal of palpable benign breast masses using the Mammotome system with ultrasound guidance is feasible, safe, and yields high patient satisfaction.