超声引导下导丝定位在触诊阴性的BI-RADSⅣ类及以上乳腺病变中的应用  

Application of ultrasound-guided guide wire positioning in patients with negative BI-RADS Ⅳ and above breast lesions

作　　者：时开元[1] 徐栋[1] 范林音[2] 何向明[3] 吴鹏[4] SHI Kaiyuan;XU Dong;FAN Linyin;HE Xiangming;WU Peng(Department of Ultrasound,Zhejiang Cancer Hospital,Hangzhou 310022,China;Department of Radiology,Zhejiang Cancer Hospital,Hangzhou 310022,China;Department of Breast Surgery,Zhejiang Cancer Hospital,Hangzhou 310022,China;Department of Pathology,Zhejiang Cancer Hospital,Hangzhou 310022,China)

机构地区：[1]浙江省肿瘤医院超声科,浙江杭州310022 [2]浙江省肿瘤医院放射科,浙江杭州310022 [3]浙江省肿瘤医院乳腺外科,浙江杭州310022 [4]浙江省肿瘤医院病理科,浙江杭州310022

出　　处：《中国现代医生》2018年第17期99-102,共4页China Modern Doctor

基　　金：浙江省自然科学基金项目(LY15H180001)

摘　　要：目的探讨超声引导下导丝定位在触诊阴性的BI-RADSⅣ类及以上乳腺病变中的临床价值及应用技巧。方法回顾性分析我院2015年1月～2017年6月150例女性患者,临床触诊阴性且超声提示BI-RADSⅣ类及以上,术前通过超声引导下导丝定位,选择合理的穿刺点,定位针尽可能与皮肤垂直,术中沿导丝切除病灶。结果150例患者共检出BI-RADSⅣ类及以上乳腺病灶157枚,超声引导下导丝定位成功率100%,手术切除率100%。病理证实良性病例数100例,病灶107枚,恶性病例数50例,病灶50枚。良性病例行区段切除,恶性病例其中31例实施保乳手术,19例实施乳腺癌改良根治术。恶性病例穿刺点均一并手术切除,且未有因穿刺点选择不当而影响手术切口选择的病例。结论术前超声引导下导丝定位可以精准切除触诊阴性的BI-RADSⅣ类及以上乳腺病变。定位针尽可能与皮肤垂直,合理选择进针点,可以快速准确的切除病灶,又不会影响恶性病例后续手术切口的选择。Objective To investigate the clinical value and application skills of ultrasound-guided guide wire positioning in BI-RADSⅣand above breast lesions with negative palpation.Methods A retrospective analyzed 150 female patients from January 2015 to June 2017 in our hospital showing negative clinical palpation and ultrasound-guided BI-RADS classⅣor above,they were preoperatively guided by ultrasound-guided wire positioning,a reasonable puncture point was selected.The positioning needle was perpendicular to the skin as much as possible and the lesion was cut along the guide wire during the operation.Results A total of 157 BI-RADS typeⅣand above breast lesions were detected in 150 patients.The ultrasound-guided guide wire placement success rate was 100%,and the surgical resection rate was 100%.Pathologically confirmed 100 cases of benign cases,107 lesions,50 cases of malignant cases,50 lesions.The benign cases were resectioned.Among the malignant cases,31 cases had breast-conserving surgery and 19 cases had modified radical mastectomy.Malignant cases were punctured with surgical excision and there was no case of surgical incision due to improper choice of puncture site.Conclusion Preoperative ultrasound-guided guidewire positioning can accurately remove BI-RADSⅣand above breast lesions with negative palpation.The positioning needle is perpendicular to the skin as much as possible,and the needle point can be reasonably selected to quickly and accurately remove the lesion without affecting the choice of follow-up surgical incision in malignant cases.

关 键 词：超声引导 导丝定位 乳腺肿瘤 BI-RADS 

分 类 号：R737.9[医药卫生—肿瘤]