本文選題：超聲引導 + 乳腺良性病灶　； 參考：《大連醫(yī)科大學》2014年碩士論文

【摘要】：目的 1.探討超聲引導下手持式真空微創(chuàng)旋切系統(tǒng)在乳腺良性病灶治療中應用價值。 2.BIRADS分級標準在乳腺旋切病例選擇中的指導作用。 資料與方法 1.資料：2012年8月---2013年8月在我院超聲科150例女性患者的423個病灶行超聲引導下微創(chuàng)旋切術(shù)，其中78例為雙側(cè)乳腺單發(fā)或多發(fā)結(jié)節(jié)，35例為單側(cè)乳腺單發(fā)結(jié)節(jié)，37例為單側(cè)乳腺單發(fā)結(jié)節(jié)，外科醫(yī)生可捫及病灶96處，主要臨床表現(xiàn)為：乳房脹痛，自述包塊感或醫(yī)生捫及包塊�；颊吣挲g16-55歲，平均年齡46.7±5.5歲。我們按BIRADS分級法和病灶直徑分為兩組。BIRADS分級：312處，Ⅲ級共111處；直徑：10mm259處，10mm＜D≤20mm141例，20mm＜D≤30mm23例。我們只選擇BIRADSⅡ-Ⅲ級，病灶直徑3mm-30mm，平均大小為18.7±4.8mm。 2.方法：術(shù)前行超聲檢查，必要時配合鉬靶及其它影像學檢查，根據(jù)BIRADS分級標準，選擇Ⅱ—Ⅲ級的病灶，病灶直徑小于30mm，由于BIRADSⅢ級的病人可能存在2%的惡性可能，所以術(shù)前要與病人與家屬溝通利弊，征得同意并簽字后方可手術(shù)。術(shù)前查肝腎功能，出凝血時間，是否服用抗凝藥。簽寫手術(shù)風險知情同意書。 患者仰臥位，雙手置于頭上，充分暴露雙側(cè)乳腺，如果病灶比較靠近外側(cè)，可要求患者側(cè)臥位，患側(cè)后方墊以小枕頭。彩色超聲引導下避開血管，確定最佳進針點，用2%利多卡因進行局部皮膚麻醉。如果是一側(cè)乳腺多發(fā)結(jié)節(jié)，則要求盡量減少穿刺進針點，做到一個手術(shù)進路切除多個結(jié)節(jié)，并且盡可能少的損傷乳腺導管。用20ml注射器針管和22G PTC針套管將利多卡因與生理鹽水的混合液注入到穿刺針道及病灶的基底部。旋切過程利用超聲判斷剩余病灶的位置方向，調(diào)整手柄上的標志點與旋切刀口的方向，并通過旋切刀手柄上的控制面板對病灶進行旋切、抽吸，直至超聲顯示目標病灶旋切干凈，確定無任何殘留后，拔出旋切刀頭及套管，結(jié)束旋切。胸部捆以彈力繃帶加壓包扎24小時。 3.旋切術(shù)后一個月、半年及一年進行影像學隨診，觀察是否有病灶組織殘留及復發(fā)情況。 4.從手術(shù)皮膚創(chuàng)口的直徑、出血量、創(chuàng)口周圍組織水腫的時間、創(chuàng)口閉合的時間、住院時間，一次性處理病灶個數(shù)及瘢痕大小幾個方面比較微創(chuàng)手術(shù)和外科開放性手術(shù)的優(yōu)勢及缺點。 結(jié)果： 1.423處病灶全部一次性旋切干凈，術(shù)畢觀察病灶區(qū)未見組織殘留及嚴重并發(fā)癥。病理結(jié)果顯示BIRADSⅡ級中良性病灶307處，占98.4%，良性病變合并不典型增生者為5處；評分為BIRADSⅢ級中良性病病變109處，占98.2%，不典型增生者1處，良性病變合并導管內(nèi)癌者1處，所有Ⅱ級和Ⅲ級的病灶均被切除干凈，，無嚴重并發(fā)癥。D≤10mm、10mm＜D≤20mm病灶均被徹底切除，無嚴重并發(fā)癥，20mm＜D≤30mm病灶也均被徹底切除，其中一例發(fā)生乳腺動靜脈瘺。合并不典型增生及導管內(nèi)癌者于術(shù)后進行開放性手術(shù)治療。術(shù)后病理提示殘腔內(nèi)未發(fā)現(xiàn)異常組織。 2.術(shù)后一個月、半年及一年進行影像學隨診，在原病灶切除部位無復發(fā)者。其中有1例單發(fā)病灶的病人在術(shù)后1年超聲檢查，發(fā)現(xiàn)一處再生結(jié)節(jié)。 3.并發(fā)癥：手術(shù)過程中3例患者出血較多，停止病灶旋切，局部按壓15分鐘，活動性出血停止，繼續(xù)手術(shù)；其中5例為殘腔內(nèi)積血，血腫于3個月后完全吸收。2例為皮膚瘀斑，均于術(shù)后2個月完全消失。 4.旋切手術(shù)術(shù)中出血量少，皮膚切口小，一次性切除所有超聲可顯示病灶，手術(shù)創(chuàng)傷小，住院時間短，瘢痕小，患者滿意度高等，較外科開放性手術(shù)有明顯優(yōu)勢，這與報道一致[1]。 結(jié)論： 1.超聲引導下手持式真空負壓微創(chuàng)治療乳腺病變是一種簡便、有效、美觀、安全的微創(chuàng)治療技術(shù)，較外科傳統(tǒng)開放性手術(shù)有明顯的優(yōu)勢，可作為乳腺良性病灶首選治療方式。 2.BIRADS分級標準使術(shù)前病例選擇標準化，可以作為乳腺旋切術(shù)前病例選擇的可靠指導標準。
[Abstract]:objective
1. to explore the value of ultrasound-guided hand-held vacuum minimally invasive rotary biopsy system in the treatment of benign breast lesions.
The guiding role of 2.BIRADS grading criteria in the selection of breast circumrotation cases.
Information and methods
1. data: 423 lesions of 150 female patients in the Department of ultrasound department of our hospital in August ---2013 August 2012 were guided by ultrasound guided minimally invasive surgery, of which 78 were unilateral or multiple nodules, 35 were unilateral and 37 were unilateral, and 96 were treated by surgeons. The main clinical manifestations were breast The patient was 16-55 years old and the average age was 46.7 + 5.5 years old. The BIRADS classification method and the lesion diameter were divided into two groups of.BIRADS grades: 312, grade III, 111; 10mm259, 10mm < D < 20mm141, 20mm < D < 30mm23. We only chose BIRADS II - III, and the focus diameter 3mm-30mm, The average size is 18.7 + 4.8mm.
The 2. method: ultrasound examination before operation, when necessary with molybdenum target and other imaging examination, according to the BIRADS grading standard, select the lesion of class II - III, the diameter of the focus is less than 30mm, because the patient of BIRADS grade III may have 2% malignant possibility, so it is necessary to communicate with the patient and family before the operation, and obtain consent and sign the operation behind the operation. Check the liver and kidney function before the bleeding time, whether to take anticoagulant drugs. Write the informed consent on operative risk.
Patients in the supine position, both hands on the head, fully exposed bilateral breast, if the focus is closer to the outside, you can ask the patient lateral position, the side pad with a small pillow. Color ultrasound guidance to avoid blood vessels, determine the best needle point, use 2% lidocaine for local skin anesthesia. If it is one of the multiple nodules of the breast, it is required to reduce as much as possible. When the needle is punctured, multiple nodules are removed by an operative approach, and the breast ducts are damaged as little as possible. The mixture of lidocaine and saline is injected into the puncture needle path and the base of the lesion with the 20ml syringe needle tube and the 22G PTC needle sleeve. The sign point and the direction of the cutting edge of the cutting knife are rotated and sucked through the control panel on the handle of the rotary cutting knife. Until the target focus is swirled clean, and no residue is determined, the rotary cutting tool and the casing are pulled out. The chest bundle is pressurized by elastic bandage for 24 hours.
After one month, six months and one year after 3. circumcision, imaging follow-up was performed to see if there were any residual tissue and recurrence.
4. compare the advantages and disadvantages of minimally invasive surgery and open surgery from the diameter of the surgical skin, the amount of bleeding, the time of edema around the tissue, the time of the wound closure, the time of hospitalization, the number of lesions and the size of the scar.
Result:
1.423 lesions were cleaned completely at one time. No tissue residual and serious complications were observed in the lesion area. The pathological results showed that 307 of benign lesions in BIRADS II, 98.4% of the benign lesions with atypical hyperplasia, 109 of BIRADS grade middle grade benign disease, 1 of the atypical hyperplasia, benign lesions, benign lesions, and benign lesions. In 1 cases of intraductal carcinoma, all lesions of grade II and grade III were removed, no serious complications were.D < 10mm, 10mm < D < 20mm was completely removed, no serious complications were found, and 20mm < D < 30mm lesions were completely removed. One of them had mammary arteriovenous fistula. Patients with atypical hyperplasia and intraductal carcinoma were opened after operation. Operative pathology revealed no abnormal tissue in the residual cavity.
2., one month, half a year and one year after the operation, there was no recurrence in the resection of the primary lesion. Among them, 1 patients with single lesion were examined by 1 year postoperatively, and a regenerative nodule was found.
3. complications: during the operation, 3 patients had more bleeding, cessation of circumcision of the focus, local compression for 15 minutes, active bleeding stop, and continued operation, of which 5 cases were hematoma in the residual cavity and the hematoma was completely absorbed by.2 as skin ecchymosis after 3 months, and all disappeared in 2 months after the operation.
4. circumflex surgery has less bleeding, small skin incision, all ultrasound can show the focus of ultrasound, the operation is small, the time of hospitalization is short, the scar is small and the patient's satisfaction is high. It has obvious advantage compared with the surgical open operation, which is consistent with the report [1].
Conclusion:
The minimally invasive treatment of breast lesions with 1. ultrasound guided vacuum negative pressure is a simple, effective, beautiful and safe minimally invasive treatment technology, which has obvious advantages over the surgical traditional open surgery. It can be used as the first choice for the treatment of benign breast lesions.
The 2.BIRADS grading standard makes preoperative case selection standardized, and can be used as a reliable guidance standard for preoperative selection of patients before excision of breast.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R445.1;R737.9

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