乳腺多发性肿块的微创手术方式选择  

Different surgical manners for the excision of multiple mammary lumps by ultrasound-guided Mammotome techniques

作　　者：金玉春[1] 丁昂[1] 陈宏亮[1] 孙建[1] 殷初阳[1] 孙太明[1] 张征[1] 宋晖[1] 王懋丽[1] 傅少梅[1] 袁永熙[1] 

机构地区：[1]复旦大学附属妇产科医院乳腺外科,上海200011

出　　处：《复旦学报（医学版）》2011年第6期527-533,共7页Fudan University Journal of Medical Sciences

摘　　要：目的研究运用微创技术(Mammotome)切除不同分布类型的乳腺多发性肿块的手术方式选择。方法选择2006年1月至2008年8月在复旦大学附属妇产科医院行Mammotome手术的1017例患者(单侧乳房肿块数量≥3个,共3 253个乳腺多发肿块),按肿块分布位置分为乳房多发性深部肿块组(A组,320例,997个肿块),乳房多发性浅表肿块组(B组,257例,804个肿块),乳房深部及浅表混合多发性肿块组(C组,440例,1 452个肿块),分析比较各组手术方式。结果 A组中,200例选择乳腺后间隙切除,平均手术时间(40±3)min、术中活动性出血9例(4.3%)、残留率(6月后)0.5%(1例)、术中疼痛发生率10.5%(21例);120例选择腺体内切除,平均手术时间(65±4)min、术中活动性出血14例(11.7%)、残留率(6月后)2.5%(3例)、术中疼痛发生率18.3%(22例)。两种术式结果比较,差异具有统计学意义(P<0.01)。B组为腺体内切除方式,进针方向分为由内而外、由外而内及由乳晕放射。105例选择由内而外手术方式,平均手术时间(48±5)min、术中活动性出血17例(16.2%)、残留率(6月后)2.8%(3例)、术中疼痛发生率15.2%(16例);64例选择由乳晕放射切除手术方式,平均手术时间(64±3)min、术中活动性出血5例(7.8%)、残留率(6月后)2.3%(2例)、术中疼痛发生率20.3%(13例);88例选择由外而内切除手术方式,平均手术时间(68±4)min、术中活动性出血16例(18.2%)、残留率(6月后)3.1%(2例)、术中疼痛发生率14.8%(13例)。残留率差异无统计学意义,其余各项指标差异具有统计学意义(P<0.01)。C组440例患者的肿块分布浅部、深部均有,根据肿块分布位置选择手术方式,平均手术时间(64±6)min、术中活动性出血70例(15.9%)、残留率(6月后)2.5%(11例)、术中疼痛发生率14.1%(62例)。结论运用微创技术切除乳腺多发肿块,手术方式应根据肿块分布的深浅选择进针位置及方向。深部肿块首先考虑乳腺后间隙切除,浅部肿Objective To evaluate and describe different surgical manners for the excision of multiple mammary lumps by ultrasound-guided Mammotome techniques.Methods One thousand and seventeen patients with 3253 mammary lumps who underwent Mammotome surgery in our hospital from Jan.2006 to Aug.2008 were divided into 3 groups according to the distribution of the lumps：group A were the patients with all the lumps at the deep layer of the mammary glands（320 patients,997 lumps）;group B were the patients with all the lumps at the shallow layer of the mammary glands（257 patients,804 lumps） and group C were the patients with the lumps at both shallow and deep layers of the mammary glands（440 patients,1 452 lumps）.The operational effects were compared between the 3 groups. Results In group A,200 patients underwent the lumps excision through the space behind the mammary glands,whose average surgical time was（40±3）min,9 cases bled（4.3%） and 21 had a pain（10.5%） in the procedure,and the residence rate was 0.5%（1 case）.Another 120 cases underwent the lumps excision through the mammary glands,whose average surgical time was（65±4）min,14 cases bled（11.7%） and 22 had a pain（18.3%） in the procedure,and the residence rate was 2.5%（3 cases）.The results had statistical differences（P 0.01）.Patients in group B underwent 3 surgical manners which were from inner to lateral,from lateral to inner and radial from the periareola.In group B,105 patients underwent lumps excision from inner to lateral,whose average surgical time was（48±5）min,17 cases bled（16.2%） and 16 had a pain（15.2%） in the procedure,and the residence rate was 2.8%（3 cases）.Sixty-four patients of group B underwent lumps excision radial from the periareola,whose average surgical time was（64±3）min,5 cases bled（7.8%） and 13 had a pain（20.3%） in the procedure,and the residence rate was 2.3%（2 cases）.Eighty-eight patients of group B underwent lumps excision from lateral to inner,whose average surgical tim

关 键 词：乳腺多发肿块 MAMMOTOME 手术方式 

分 类 号：R655.8[医药卫生—外科学]