吲哚菁绿乳管造影在乳头溢液手术中对溢液乳管定位和病变腺体标记的可行性研究  

Feasibility study of indocyanine green lactigraphy for the location of nipple discharge duct and the marking of diseased glands during nipple discharge surgery

作　　者：张钊[1] 骆成玉 何平[1] 张树琦[1] Zhang Zhao;Luo Chengyu;He Ping;Zhang Shuqi(Department of General Surgery,Beijing Anzhen Hospital,Capital Medicine University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京安贞医院普外科,北京100020

出　　处：《中华普外科手术学杂志（电子版）》2023年第3期323-327,共5页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：2018年度(第四批)“青苗”计划项目(QML20180602)。

摘　　要：目的探讨吲哚菁绿乳管荧光造影在乳头溢液术中对溢液乳管定位及病变腺体标记的可行性及临床应用价值。方法回顾性分析2018年5月至2021年5月178例手术治疗的病理性乳头溢液患者临床资料,术中均行钼靶乳管造影和吲哚菁绿乳管造影检查。应用SPSS 25.0软件分析数据,计量资料采用(x^(-)±s)表示,行独立样本t检验;计数资料采用[n(%)]表示,采用χ^(2)或Fisher检验。P<0.05为差异具有统计学意义。结果178例患者共计193个溢液乳管,其中良性病变133个(68.9%),恶性病变40个(20.7%),交界性病变20个(10.4%);单侧、单孔溢液较多,以黄色浆液性溢液多见。钼靶乳管造影示,溢液乳管84个(43.5%)呈“树干征”,109个(56.5%)呈“树征”;腺体类型以不均匀致密型最多见,且多位于内下象限。吲哚菁绿乳管造影示,132个(68.4%)溢液乳管直接透过皮肤荧光显影,55个(28.5%)未透过皮肤显影,6个(3.1%)皮下淋巴管荧光显影。不同年龄、病变象限及钼靶影像学征象溢液乳管的吲哚菁绿显影表现差异具有统计学意义(P<0.05)。不同荧光显影溢液乳管管径差异无统计学意义(P>0.05),溢液乳管至皮肤的距离差异有统计学意义(P<0.05)。结论吲哚菁绿乳管荧光造影表现与患者年龄、溢液乳管象限位置、钼靶造影征象及溢液乳管至皮肤的距离有关;吲哚菁绿乳管荧光造影用于乳头溢液手术中能够精准定位病变乳管,合理设计手术切口,完整切除病变腺体系统,具有临床应用价值。Objective To investigate the feasibility and clinical value of indocyanine green emulsion duct fluoresceography in nipple discharge surgery to locate the nipple discharge duct and mark the diseased glands.Methods Retrospective analysis was performed on the clinical data of 178 patients with pathological nipple discharge who underwent surgical treatment from May 2018 to May 2021.Molybdenum target lactography and indocyanine green lactography were performed intraoperatively.SPSS 25.0 software was used to analyze the data.The measurement data were expressed by(x^(-)±s),and independent sample t test was performed.The count data were represented by[n(%)]andχ^(2) or Fisher test was used.P<0.05 was considered statistically significant.Results There were 193 overflowing milk ducts in 178 patients,including 133 benign lesions(68.9%),40 malignant lesions(20.7%),and 20 borderline lesions(10.4%).Unilateral and single-hole overflow is more common,with yellow serous overflow.Mammography showed that 84(43.5%)of the milk ducts with discharge showed“trunk sign”and 109(56.5%)showed“tree sign”.The most common types of glands were inhomogeneous and dense,and mostly located in the inner and lower quadrant.Indocyanine green lactigraphy showed that 132(68.4%)of the discharge lactis were fluorescined directly through the skin,55(28.5%)were not fluorescined through the skin,and 6(3.1%)of the subcutaneous lymphatic lactis were fluorescined.There were significant differences in the development of indocyanine green in different age,pathological quadrants and molybdenum target imaging signs of discharge milk duct(P<0.05).There was no statistically significant difference in the diameter of overflow milk duct in different fluorescein imaging(P>0.05),but there was statistically significant difference in the distance between overflow milk duct and skin(P<0.05).Conclusion The results of indocyanine green emulsion duct fluoroscopy were related to the age of the patient,the quadrant location of the discharge duct,molybdenum target imaging

关 键 词：乳头溢液 外科手术 吲哚菁绿 乳管造影 荧光显影 

分 类 号：R655.8[医药卫生—外科学]