超声引导下mammotome微创旋切在乳腺不可扪及肿块切除中的应用

目的:探讨B超定位引导下mammotome切除乳腺不可扪及肿物的临床价值.方法:使用B超高频探头,对37位女性40个临床检查触不及的乳腺肿物作术前体表定位,按定位对40个肿物行麦默通切除术.结果:40个肿物皆被准确切除,病理结果为导管内癌3例,多发性乳头状瘤3例,非典型增生10例,纤维瘤8例,纤维囊性乳腺病伴瘤样增生结节13例,正常乳腺组织3例.结论:B超引导麦默通对不可扪及阴性乳腺肿物切除准确,方便,美观,可用于乳腺体表不可扪及肿块早诊断和治疗.     

超声引导下切除体表不可扪及的乳腺肿块

目的：探讨不可扪及的乳腺肿物B超定位引导切除的临床价值.方法：使用B超高频探头,对43例女性52个临床检查不能触及的乳腺肿物作术前体表定位及肿物周注射美蓝,按定位对52个肿物行切除术.结果：43例患者肿物皆被准确定位切除,52个肿物中病检结果为浸润型导管癌3个,导管内癌4个,小叶原位癌2个,癌变率为17.3%（9/52）,多发性乳头状瘤3个,非典型增生19个,纤维瘤8个,纤维囊性乳腺病伴瘤样增生结节6个,正常乳腺组织7个.结论：B超引导对不可扪及乳腺肿物切除准确,方便、经济,可广泛用于乳腺体表不可扪及肿块早期诊断和治疗.     

超声引导下切除体表不可扪及的乳腺肿块

目的:探讨不可扪及的乳腺肿物B超定位引导切除的临床价值.方法:使用B超高频探头,对43例女性52个临床检查不能触及的乳腺肿物作术前体表定位及肿物周注射美蓝,按定位对52个肿物行切除术.结果:43例患者肿物皆被准确定位切除,52个肿物中病检结果为浸润型导管癌3个,导管内癌4个,小叶原位癌2个,癌变率为17.3%(9/52),多发性乳头状瘤3个,非典型增生19个,纤维瘤8个,纤维囊性乳腺病伴瘤样增生结节6个,正常乳腺组织7个.结论:B超引导对不可扪及乳腺肿物切除准确,方便、经济,可广泛用于乳腺体表不可扪及肿块早期诊断和治疗.     

乳导管镜联合麦默通在微创切除乳腺管内微小肿物中的应用

目的：探讨超声引导下乳导管镜联合麦默通微创旋切系统在切除乳腺导管内微小肿物中的应用价值。方法：60例于我科就诊的乳头溢液病例,溢液涂片中见到增生细胞,细胞学1—2级。经乳管镜诊断为乳腺导管内微小肿物的女性患者,在超声引导下行乳导管镜联合麦默通微创旋切术,术后随访3—6个月。结果：60例乳腺导管内微小肿块在乳导管镜及彩超指引下麦默通微创旋切完整切除,病理结果阳性率100％,其中2例为导管内原位癌,1例为浸润性导管癌,其余均为导管内乳头状瘤,术后59例患者无手术疤痕。结论：超声引导下乳腺导管镜联合麦默通微创旋切乳腺导管内微小肿物具有定位准确、病理诊断明确、切除完整率高、创伤小、美观等优点。     

彩超引导下麦默通系统诊治乳腺疾病的价值探讨

在彩色超声引导下,利用麦默通(Mammotome)系统对107例患者的216个乳腺病灶进行切除,并记录术后病理及其随访情况,以探讨彩超引导下使用麦默通系统对乳腺病灶进行微创切除及其活检的临床应用价值.107例患者216个乳腺病灶完整切除,切除组织足够用于病理诊断,141例次病理结果为纤维腺瘤,62例次为乳腺腺病,其中2例次为导管上皮不典型增生,3例次为导管内乳头状瘤,8例次为乳腺癌.3例出现局部血肿,6例次出现皮下淤血.初步研究结果提示,麦默通技术是一项准确、有效、安全、创伤小、并发症少并且美容效果好的乳腺微创切除、活检技术,可对乳腺良性病灶进行切除,并且能够早期发现乳腺癌.     

真空微创系统对乳腺病灶诊治的临床探讨

目的：探讨超声引导下使用Mammotome（麦默通）系统对乳腺病灶进行微创切除及其活检的临床应用价值。方法：在超声图像监控下，利用Mammotome（麦默通）系统对89例患者100个乳腺病灶进行切除或活检，并记录术后病理结果及其随访情况。结果：89例患者100个乳腺病灶被准确完全切除或进行活检．切除组织足够用于病理诊断：43个病灶结果为纤维腺瘤．19个为硬化性腺病，2个为导管上皮不典型增生．36个为乳腺癌。2例出现局部血肿，4例皮下瘀血。结论：Mammotome（麦默通）技术是一项切除准确、有效、安全、创伤小、并发症少的乳腺微创技术．可对乳腺良性病灶进行切除．并可用于乳腺恶性肿瘤手术前活检。     

B超引导下乳腺隐匿性病灶定位切除分析

[目的]探讨B超发现乳腺隐匿性病灶定位切除的方法.[方法]选取2000年9月至2004年9月的377例B超发现有乳腺隐匿性病灶的患者进行研究.其中103例分别选择在B超引导下乳腺定位针穿刺金属丝定位切除(A组33例)或体表定位切除(B组70例),比较两组只行区段切除病例的术后美容效果.[结果]103例中乳腺癌11例,发现率为10.68%.10例乳腺癌行全乳切除,1例行保乳术.另1例重度不典型增生和1例导管内乳头状瘤病也行全乳切除术.只行区段切除者91例其中A组30例(包括1例保乳术),B组61例,术后3个月的美容效果评价结果美容效果良好者A组29例(96.67%),B组42例(70.49%).两组差异有显著性(P＜0.001).[结论]B超引导下乳腺定位针穿刺金属丝定位切除,操作简便,定位准确可靠,有利于保证病变的切除和减少不必要的乳腺损害,为乳腺隐匿性病灶的准确诊断创造了条件.     

麦默通微创术治疗乳腺良性肿块的护理

目的:总结麦默通在B超引导下切除乳腺良性肿块的护理。方法:回顾性总结120例乳腺良性肿块患者在B超立体定位下行麦默通微创切除术,护士在术前、术中、术后的护理。结果:120例患者的乳腺肿块均完整切除。术中出血量≥50 ml者6例;术后手术区皮下出现瘀斑5例;术后扪及波动感强烈的大血肿4例;术后出现小血肿3例;手术伤口剧烈疼痛1例;术后无感染病例。结论:通过护士在术前做好健康宣教,术中密切配合,术后认真仔细的观察护理,有效降低了麦默通术后的并发症,提高了患者的满意度。     

Mammotome微创旋切系统在乳腺病灶切除中的应用

为了探讨麦默通 (Mammotome)微创旋切系统在乳腺病灶切除中的价值及手术技巧,对412例751个乳腺病灶在超声引导下进行了Mammotome乳腺微创旋切术.结果显示,751个乳腺病灶被切除,手术成功率100.0%.病理结果乳腺癌8例,7例行乳腺癌根治术,1例行保留乳房术,其中3例病理组织中未见有癌细胞残留. 良性疾病404例,其中不典型增生5例;纤维腺瘤340 例;导管内乳头状瘤11例;乳腺腺病及增生症36例;其他12例.术后乳房上仅留有0.5~1.0 cm微小瘢痕.发生局部血肿35例,皮下淤血14例,无感染及其他并发症.3～6个月B超复查均未见复发.初步研究结果提示,Mammotome乳腺病灶微创手术是一种定位准确、损伤小、恢复快,几无手术瘢痕的一种新型手术方式,尤其适合多发性乳腺肿块及隐匿性肿块的切除.     

超声引导麦默通旋切系统切除乳腺良性肿块368例临床观察

目的探讨超声引导下麦默通旋切系统在乳腺良性肿块微创手术中的应用价值。方法对368例共925枚乳腺肿块,在超声“十”字交叉定位引导下行麦默通微创旋切术。术后3个月超声评价疗效。结果所有肿块在超声引导下完全切除并行活检,术后病理诊断均为良性病灶。术后11例出现切口附近皮肤压力性水疱,2周后皮痂脱落痊愈;16例出现局部瘀斑及血肿,1～2个月后消退;术后3个月超声复查原病灶部位未见肿块残留与复发迹象。结论超声引导下麦默通旋切系统切除乳腺良性肿块具有定位准确、创伤小、操作简单、安全及疗效好等优点,值得在临床上推广应用。     

Sonographically guided mammotome excision of ducts in the diagnosis and management of single duct nipple discharge.

AIM: To describe our experience in the use of ultrasound guided mammotome in the diagnosis and management of single duct nipple discharge. METHODS: Patients for whom surgical excision of the single duct had been advised for single duct nipple discharge were offered ultrasound guided mammotome excision of the duct as an alternative to surgical excision. The procedure was performed in the breast clinic by a surgeon or a breast clinician who had interventional ultrasound skills. RESULTS: Seventy-seven patients had 81 procedures. Follow-up at a mean time of 16 months revealed resolution of the presenting problematic discharge in 95% of patients. Nipple discharge recurred in four patients. Two patients had microdochectomy and two had a repeat mammotome for recurrence of symptoms. Complications were mild and infrequent. CONCLUSION: Ultrasound guided mammotome excision is a new tool in the work up and management of single duct nipple discharge. It can be performed under local anaesthetic by a surgeon/breast clinician or radiologist with interventional ultrasound skills. It has the potential to replace surgical excision (microdochectomy) as a treatment for nipple discharge.     

超声引导下mammotome微创旋切乳腺肿块42例分析

目的:探讨mammotome微创旋切手术对乳房肿块的诊断和治疗价值。方法:对42例68处乳腺肿块进行了超声引导下mammotome微创旋切术,评价其诊断和治疗效果。结果:40处乳腺病灶为乳腺纤维腺瘤,19处为乳腺纤维腺瘤形成趋势,7处为乳腺腺病,2处术中诊断为乳腺囊肿,术后病理为纤维脂肪组织。67处病灶被切除,1处纤维腺瘤术中出血终止手术。1例单发纤维腺瘤处术后并发严重出血,1例术中机械故障顺利排除。皮肤切口3mm,每个病灶平均旋切28次,手术时间平均为30分钟。B超随访1~6个月无复发。结论:超声引导下mammotome微创旋切手术对乳腺良性病灶能明确诊断且切除彻底,皮肤疤痕小,美容效果好。     

Mammotome微创旋切系统切除乳腺多发良性肿物的应用研究

为了探讨超声引导下应用Mammotome旋切系统切除乳腺多发良性肿物的可行性和手术要点，采用Mam-motome旋切系统对43例185处4-25mm乳腺病灶进行B超引导下Mammotome微创旋切手术，评价手术效果和总结手术经验。185个乳腺病灶均被Mammotome微创旋切系统完全切除，术后病理诊断乳腺纤维瘤128个病灶，乳头状瘤13个病灶，24个病灶为乳腺腺病，20个病灶纤维瘤样增生。术后B超随防3-6个月，未发现乳腺残留病灶，总并发症率21％。初步研究结果提示，应用Mammotome微创旋切系统切除乳腺多发良性肿物可完全切除病灶并获得理想美容学效果，并发症轻微不需处理，多发良性肿瘤手术经验需要进一步探索。     

超声引导下Mammotome旋切系统在诊断临床不可触及乳腺病灶应用研究

目的 探讨超声引导下应用Mammotome旋切系统,在临床不可触及乳腺病灶的诊断应用价值.方法 2004年6月～2004年9月,采用11 G自动活检刀头对123例265处＜15 mm临床不可触及的乳腺病灶进行B超引导下Mammotome微创旋切术,评价其对临床不可触及乳腺病灶的诊断效果.结果265个乳腺病灶大小3 mm～15 mm(平均9.1 mm),均被Mammotome微创旋切切除.结果术后病理诊断阳性31个病灶(包括不典型增生ADH,原位癌DCIS,LCIS,浸润癌).234个病灶为良性病变.术后B超随防3个月～6个月,未发现乳腺残留病灶.结论应用B超引导下Mammotome旋切系统对临床不可触及乳腺病灶可进行完整切除并获得明确病理组织学诊断,若为良性可获得理想美容学效果,若为恶性可使患者获得早期治疗,提高生存期.     

Stereotactic breast biopsy: An audit of 18 months at BreastScreen Auckland

Stereotactic biopsy has become a widely used technique for marnmographically detected lesions that are clinically and sonographically occult. Vacuum‐assisted (mammotome) biopsy on a dedicated prone stereotactic unit has further increased ease of biopsy and utility of the technique. Results of an 18‐month audit in the national breast screening programme (BreastScreen Auckland and North) in the Auckland region demonstrates results comparable with those achieved elsewhere. Of a total of 399 stereotactic biopsies, 23 were excluded as they were 14‐G core biopsies rather than 11‐G mammotome biopsies. Of 376 mammotome biopsies, 10 (2%) failed, 266 (70.7%) were benign, 39 (10.3%) were atypical ductal hyperplasia (ADH) and 70 (18.6%) were malignant. Of these, 14.6% were ductal carcinoma in situ (DCIS) and 4% were invasive carcinomas. All cases diagnosed as ADH underwent formal excision biopsy. Of the 39 cases, 33 demonstrated benign disease or residual ADH only on excision (84.6%) and six (15.4%) patients were upgraded: five to DCIS and one to invasive carcinoma. The significant complication rate was 0.5%. Indications for biopsy were calcification in 89% of cases, mass lesions in 10.6% of cases and architectural distortion in 0.2% of cases. The failure rate of 2% compares with hookwire biopsy series. Practical issues and protocols have been presented.     

Preoperative mammotome biopsy of ducts beneath the nipple areola complex.

AIM: To evaluate the role of ultrasound guided mammotome biopsy of the ducts beneath the nipple areola complex (NAC), as a new technique in detecting the occult involvement of the NAC in breast cancer patients prior to nipple preserving subcutaneous mastectomy. METHOD: A prospective study where 33 women requesting nipple preserving mastectomy for invasive or in situ disease were offered the procedure to determine if leaving the nipple was safe. A 5 mm skin incision was made after infiltration with local anaesthetic and the 11G mammotome needle was positioned beneath the nipple under ultrasound guidance which was turned through 360 degrees as the biopsies were taken. The procedures were performed by trained non-radiologists. RESULTS: Thirty-three women had 36 procedures. Seven out of the 36 had a positive mammotome biopsy. Twenty-three patients had 26 NAC preserving mastectomies with immediate reconstruction. Three had bilateral procedures. Ten patients had NAC sacrificed. The histopathology of the mastectomy specimen correlated 100% with the mammotome biopsy. CONCLUSION: Preoperative ultrasound guided mammotome biopsy of the ducts beneath the NAC is a safe, reliable and accurate technique and is evolving as an oncologically safe procedure. The large mammotome needle can be visualized easily under high resolution, near field high frequency scanners and this increases the accuracy of the biopsy. It can replace the traditional frozen section and be used as an alternate. It can be performed safely by an appropriately trained non-radiologist (surgeon/breast clinician).     

B超引导空芯针穿刺活检对于乳腺肿块诊断作用的分析

目的：评价B超引导空芯针穿刺活检（core needle biopsy,CNB）在可触及的乳腺肿块中的临床应用价值,同时讲述操作中的技术事项。方法：回顾分析可触及肿块的乳腺疾病住院患者的临床和病理资料,总结B超引导CNB的适应证、优缺点、注意点。结果：CNB的敏感性为94.85%,假阴性为5.15%;病理低估为5.83%;诊断符合率为89.32%。14Gauge穿刺针的标本数应该是3根以上的合格标本;行ER、PR、neu检测的患者,需取合格穿刺标本4根以上。结论：对于临床可触及的乳腺肿块,该检测方法有较高的临床应用价值。B超引导CNB适用于超声发现的乳腺病灶。B超引导的CNB的优点是明显缩短手术时间和避免了手术切除肿块时可能带来的肿瘤播散。从术中冰冻病理到术前明确诊断是一种治疗模式的转变。     

Mammotome旋切系统在老年乳腺癌诊断中的应用

目的:总结我科应用Mammotome旋切系统对老年乳腺癌在诊断中的应用价值。方法:对29例60岁以上已绝经老年乳腺癌的病人应用Mammotome旋切系统活检,获得组织信息。结果:29例病人经Mammotome旋切系统活检获得了明确诊断及免疫组化结果,对无法耐受化疗者6例根据免疫组化结果行新辅助内分泌治疗,5例经行新辅助化疗后临床降期,行保乳治疗,5例行全乳切除,余者行乳腺癌改良根治术,手术后根据患者状况进行内分泌治疗或化疗。结论:老年乳腺癌病人临床合并症多,部分不能接受化疗或常规手术,受体阳性占多数,Mammotome旋切系统活检获得组织量大,可提供安全可靠的病理及受体结果,尤其对老年乳腺癌病人的新辅助内分泌治疗提供保证,具有穿刺和空心针活检所达不到的优势,应用前景广阔。