超声引导导丝定位术对乳腺不可触及肿块的精准切除  

Application study of ultrasound-guided wire localization for precise excision of non-palpable breast lesions

作　　者：刘晶焰 彭玉兰[1] 苟泽辉[1] 骆洪浩[1] 赵海娜[1] 张琼[1] 马步云[1] 卢强[1] 吕青[2] 阎锋 于波洋[1] 田野[1] 陈爽[1] 凌文武[1] LIU Jingyan;PENG Yulan;GOU Zehui;LUO Honghao;ZHAO Haina;ZHANG Qiong;MA Buyun;LU Qiang;LYU Qing;YAN Feng;YU Boyang;TIAN Ye;CHEN Shuang;LING Wenwu(Department of Ultrasonography, West China Hospital, Sichuan University, Chengdu 610041, China;Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, China;Clinical Ultrasound Imaging Drug Research Lab, West China Hospital, Chengdu 610041, China)

机构地区：[1]四川大学华西医院超声医学科,四川成都610041 [2]四川大学华西医院乳腺外科,四川成都610041 [3]四川大学华西医院临床超声影像药物研究室,四川成都610041

出　　处：《西部医学》2021年第4期561-566,共6页Medical Journal of West China

基　　金：国家自然科学基金面上项目(81571694)。

摘　　要：目的总结超声引导导丝定位术的经验及其对临床微创精准切除乳腺不可触及肿块的应用价值。方法回顾性分析我院近13年开展的乳腺超声引导导丝定位的患者资料,对病变的大小、位置、手术结果、病理类型等进行统计分析,总结超声引导导丝定位的临床工作流程、操作技术要领,通过手术切除效果、超声复查和与外科医师交流等,评估超声引导导丝定位对外科医师处理不可触及乳腺肿块的价值。结果共计985例患者、1166个乳腺不可触及肿块在术前进行了超声引导导丝定位。患者年龄16~77岁,中位年龄为45岁。参与导丝定位的超声医师11名,从事介入超声的工龄1~20年。共切除肿块1166个,术后复查,无1例漏切。全部病变的中位直径为10(2,41)mm,病变最大径≤20 mm,占比95.37%。恶性病变的中位最大径为10(4,36)mm,良性病变的中位最大径为9(2,41)mm,良性和恶性病变的中位最大径有统计学差异(P<0.05)。病变分布在不同象限中,良恶性病变的位置分布没有统计学差异(P>0.05)。术后病理结果,良性病变1064个(91.25%),恶性病变102个(8.75%)。在恶性病变中,原位癌35个,浸润癌66个,未分化多形性肉瘤1个。因超声引导导丝定位而产生的血肿、感染、气胸、导丝移位0个,超声图像导丝定位准确但临床反馈导丝定位位置太浅4例。结论超声引导导丝定位既解决了不可触及乳腺肿块外科医师精准切除的难题,又符合微创外科满足现代女性对乳腺形状的美观需求,可在临床推广应用。Objective To summarize the experience of ultrasound-guided guide wire localization and its application value in minimally invasive and accurate resection of non palpable breast masses.Methods The cases of breast UGWL in our hospital in the past 13 years were included.The size,location,surgical results,and pathological types of the lesions were summarized and statistically analyzed.The clinical workflow and operating technical essentials of UGWL were condensed and summarized.The value of UGWL for surgeons in treating NPBL through surgical resection results,ultrasound review and communication with surgeons were evaluated.Results A total of 985 patients,1166 non-palpable breast lesions were guided by ultrasound-guided wire before operation.The patients ranged in age from 16 to 77 years,with a median age of 45 years.There are 11 ultrasound doctors involved in wire positioning,and have worked in interventional ultrasound for 1 to 20 years.A total of 1166 lesions were removed.After operation review,no cases were missed.The median diameter of all lesions was 10(2,41)mm,and the largest diameter of lesions≤20 mm accounted for 95.37%.The median maximum diameter of malignant lesions was 10(4,36)mm,the median maximum diameter of benign lesions was 9(2,41)mm,and the median maximum diameter of benign and malignant lesions was statistically different(P<0.05).The distribution of lesions in different quadrants,the location distribution of benign and malignant lesions was not statistically different(P>0.05).Postoperative pathological results showed 1064 lesions(91.25%)of benign lesions and 102 lesions(8.75%)of malignant lesions.Among the malignant lesions,there were 35 of carcinoma in situ,66 of invasive carcinoma,and 1 of undifferentiated pleomorphic sarcoma.There were 0 hematoma,infection,pneumothorax,and guidewire displacement caused by UGWL.Ultrasound images showed that the guide wire was positioned accurately but the clinical feedback was too shallow in 4 cases.Conclusion Ultrasound-guided wire localization not only solves

关 键 词：乳腺 超声 导丝定位 不可触及肿块 微创切除 

分 类 号：R655.8[医药卫生—外科学] R445.1[医药卫生—临床医学]