超声引导下麦默通微创切除乳腺肿块的护理配合

目的探讨B超引导下麦默通行乳腺肿块切除中的应用价值及手术配合技巧。方法26例临床病例结合超声诊断的乳腺良性肿块的女性患者,在超声引导下,使用麦默通行乳腺肿块微创切除术。结果 26例女性患者共30个乳腺肿块,其中良性肿块26个,乳癌病灶4个,术中显示肿块完整切除,单侧肿块切除平均时间12 min,术后复查有1例未被完全切除,完整切除率为96.7%。结论超声引导麦默通对乳腺肿块微创切除定位准确,是一种合理、安全、不留疤痕及有效的微创检查和治疗方法。     

真空辅助活检诊断乳腺导管上皮不典型增生的组织学低估及切缘残留问题的研究

目的分析真空辅助活检(VAB)诊断乳腺导管上皮不典型增生(ADH)的组织学低估及病灶切缘残留情况。方法将临床不可触及的乳腺病变(NPBL)通过VAB诊断为ADH的165例患者再次切除病灶进行活检,统计其组织学低估率及切缘阳性率。结果 VAB诊断乳腺ADH的组织学低估率为9. 1%。其中钼靶立体定位真空辅助活检(SVAB)诊断乳腺ADH的组织学低估率为10. 5%,超声引导下真空辅助活检(UGVAB)诊断乳腺ADH的组织学低估率为7. 9%,两组低估率差异无统计学意义。VAB术后切缘残留率为37. 8%。其中SVAB术后切缘残留率为39. 5%,UGVAB诊断乳腺ADH的组织学低估率为36. 0%,两组比较差异无统计学意义。结论真空辅助旋切活检可有效检出ADH,组织学低估率较低,但由于组织学诊断的低估以及较高的切缘阳性率,真空辅助旋切活检尚不能完全代替切除活检。     

超声引导下微创旋切活检术治疗乳腺不可触及肿物的临床价值

目的:探讨超声引导下微创旋切活检术在乳腺不可触及肿物中定性和治疗的临床应用。方法:应用超声引导下Encor微创旋切系统对169例患者的乳腺不可触及肿块278个病灶(最大径0.3～0.8 cm)进行活检,病灶的超声BI-RADS(BreastImaging Reporting and Data System)分级为:0级46个,Ⅱ级36个,Ⅲ级121个,Ⅳ级75个;并根据病灶的大小持续切割,直到完整切除。结果:278个乳腺肿块术后病理诊断乳腺纤维瘤113个,乳腺增生32个,纤维硬化性腺病47个,乳腺腺病35个,纤维瘤样增生24个,复合囊肿10个,不典型增生15个,浸润性导管癌2个(临床分期为T1N0M0)。术后3～6个月复查彩色多普勒超声:8例手术创腔部位考虑占位性病变6,例仍给予超声引导下微创旋切活检切除,2例给予开放性手术切除;术后病理:5例为纤维硬化性腺病3,例结合临床考虑为瘢痕组织形成;其余161例局部肿块消失,未见复发。结论:超声引导下真空辅助微创旋切手术诊治不可触及乳腺肿块不仅定位准确,美容效果好,更重要的是能检出临床上高危患者中的早期乳腺癌。     

超声引导下乳腺肿块Mammotome微创旋切术及其临床应用

目的探讨超声引导下微创旋切手术对乳房肿块的诊断与治疗。方法对109例136处乳腺肿块进行了超声引导下旋切术,评价其诊治效果。结果109例136处乳腺肿块中,96例123处乳腺肿块临床诊断为乳腺纤维腺瘤,均被Mammotome微创旋切切除,13例经Mammotome微创旋切术进行活检术。所有操作均成功,皮肤伤口仅3mm,无并发症。结论超声引导下乳腺肿块旋切术操作方便易学,对乳腺小纤维腺瘤切除彻底,皮肤疤痕微小;对可疑病灶能及时明确诊断,合理治疗。     

麦默通乳腺活检系统在乳腺良性肿瘤微创手术中的应用体会

目的 探讨B超引导下麦默通乳腺活检系统对乳腺良性肿瘤的治疗效果及操作技巧.方法 对58例66处乳腺良性肿瘤行B超引导下麦默通乳腺活检系统微创旋切术,评价其对乳腺良性肿瘤的治疗效果.结果 所有乳腺良性肿瘤,术后超声扫描均提示病灶消失.患者乳房上仅留下0.3 cm的微小切口,手术操作简单,平均手术时间35 min.5例患者术后出现局部轻度皮下淤血或原病灶切除处创腔积血,经处理后均痊愈.其中38例患者随访6～18个月,临床及B超检查均无肿瘤残留及复发迹象.结论 超声引导下麦默通乳腺活检系统切除乳腺良性肿瘤具有穿刺准确、创伤小、操作简单、安全、术后瘢痕小、并发症少等优点,尤其适合于直径3.0 cm以下的乳腺良性肿瘤,是一种值得推广的手术方法,但术中应注意确保病灶完整切除.     

B超引导下麦默通微创旋切系统在乳腺肿块中的应用价值

目的 探讨B超引导下麦默通系统在乳腺肿块切除及活检中的应用价值.方法 455例667个乳腺病灶在B超引导下进行麦默通微创切除术或活检术,并进行回顾性分析及评价其在乳腺外科的应用价值.结果 术后病理学诊断43个乳腺浸润性导管癌,6个单纯癌,3个髓样癌,615个病理学诊断为良性病变,其中2个慢性化脓性炎症.52个乳腺癌患者均住院接受开放性手术切除或保乳手术,未发生组织学低估.所有病理诊断良性病变患者术后3、6个月均接受B超复查,均未发现手术残留病灶.结论 应用B超引导下麦默通旋切系统对乳腺病灶可进行微创完整切除并能获得明确病理组织学诊断.     

麦默通微创旋切治疗乳腺肿块效果观察

目的探讨麦默通微创旋切系统在乳腺肿块切除中的应用价值和前景。方法在超声引导下采用麦默通旋切系统对56例乳腺肿块患者行肿块切除术,观察临床效果。结果 56例共72个病灶均一次性完整切除,病理报告良性病灶69个,恶性病灶3个。术后出现局部皮肤青紫3例,乳房内血肿2例,均保守治疗治愈;3例乳腺浸润性导管癌患者给予手术、化疗等综合治疗。全部病例未发生感染及血气胸,随访半年未见复发。结论乳腺肿块采用超声引导下麦默通旋切系统切除,微创、美观、操作精简和并发症少的特点,安全性较高,值得临床推广。     

微创手术麦默通治疗150例乳腺良性肿块的临床研究

目的:观察微创手术—麦默通(Mammotome)在乳腺良性肿块切除中的疗效。方法:采用超声引导真空辅助乳房活检系统(麦默通)切除150例乳腺良性肿块,比较该方法与传统手术切除在术前准备、手术时间、术后并发症和恢复状况等方面的差别,评价其临床应用价值。结果:共切除162个良性肿块,皮肤切口平均为6 mm,旋切次数平均为10次,手术时间平均为15 min,术后超声扫描显示肿块完全被切除;术后并发症主要为轻度疼痛(68.0%)、局部血肿(5.3%)和乳房皮下淤血(2.7%),未见局部感染和气胸,患者未见明显瘢痕形成。结论:B超引导下的麦默通微创旋切系统在乳腺良性肿块切除中具有定位准确、切口小、出血少、患者恢复快的特点,是一种并发症少且安全可靠的治疗方法。     

真空辅助乳腺微创旋切系统临床应用现状及进展

目的探讨真空辅助乳腺微创旋切系统临床应用价值及进展。方法复习近年最新文献资料,综述成文。结果真空辅助乳腺微创旋切系统近年在国内外广泛应用,主要用于乳腺肿块的活检及良性肿块的微创切除,取得了一定经验及进展。结论真空辅助乳腺微创旋切系统切除乳腺病灶,具有损伤小、操作简单、快捷、美观等优点。在乳腺良性肿块及临床不可触及病灶切除方面应用方泛,值得推广。     

麦默通旋切术对乳腺良性肿瘤的治疗价值

目的探讨超声引导下麦默通微创旋切术对乳腺良性肿块的临床应用价值。方法对在津南区咸水沽医院行超声引导下麦默通微创旋切治疗的108例女性患者124处乳腺病灶进行总结,评价其疗效。结果所有病灶直径范围5~37mm,组织病理诊断乳腺纤维瘤105个,乳腺硬化性腺病11个,乳腺囊性增生8个。术后均未出现疼痛、出血、感染、皮肤损伤等并发症。结论超声实时引导下麦默通旋切系统为乳腺良性肿块的临床治疗提供了新的途径,不仅能够准确切除乳腺肿块,还具有微创、安全、有效、美容等优点,在减轻患者精神压力的同时还能提高生活质量,可以作为较小良性结节的首选治疗方法。     

Impact of benign breast biopsy upon breast self-examination

Current American Cancer Society guidelines recommend monthly performance of breast self-examination (BSE) for women over 20 years of age. While the experience of a benign breast biopsy can result in elevated levels of distress, the impact of benign biopsy upon breast cancer (BC) screening behavior is not well known. The present study examined frequency of BSE practice in 102 women after benign breast biopsy (biopsy group). Telephone interviews were completed a mean of 21 days (initial interview) and 8 months after biopsy (follow-up interview). A healthy comparison (HC) group of women (n = 76) without a history of breast biopsy completed an initial interview only. Information regarding distress, dispositional characteristics, BC screening-related attitudes and behaviors, and subjective and objective risk for BC was collected. Results indicated that the biopsy and HC groups did not differ in typical (i.e., prebiopsy) practice of BSE. However, practice of BSE changed after biopsy with a general trend toward a decrease in BSE frequency. Only 8% of women in the biopsy group reported appropriate (once per month) practice of BSE at the 8-month Follow-up while 28% reported appropriate practice at the initial interview. Decreases in BSE performance after biopsy were characteristic of younger women, women who lacked confidence in the ability to perform BSE correctly, and women whose biopsy was preceded by discovery of a breast lump or abnormality during BSE. Results suggest the potential value of a psychoeducational intervention after biopsy to enhance appropriate performance of BSE.     

The role of clinical breast examination and breast self-examination

The efficacy of screening by clinical breast examination (CBE) and/or breast self-examination (BSE) is reviewed using indirect evidence from randomized breast screening trials and that from observational studies. In countries where breast cancer is diagnosed at an advanced stage, screening by CBE with the teaching of BSE as an integral component will probably be effective in reducing breast cancer mortality. However, in technically advanced countries where adequate treatment is given, no screening modality is likely to be sufficiently beneficial to outweigh the harms of screening, especially false positives and over-diagnosis.     

乳腺癌保乳治疗中的相关问题

目的:探讨早期乳腺癌保乳治疗的相关问题。方法:通过对51例乳腺癌保乳治疗病例的回顾性分析,总结其综合治疗的经验体会。同时对乳腺癌保乳治疗中病人的生活质量、经济承受能力、综合治疗的顺序等问题予以综合性分析。结果:除1例患者外,所有乳腺癌保乳手术病例均实施规范化治疗,中位随访时间12.7个月,局部复发率0.02%。结论:乳腺癌保乳治疗相关问题的处理方法是可行的。     

乳腺不可触及肿物超声引导下定位的分析

目的:探讨乳腺不可触及肿物超声引导下定位的临床价值。方法:对2008年该院收治住院100例乳腺不可触及肿物的患者进行超声引导下导丝定位,并切除。结合手术后病理组织学诊断进行分析。结果:二维图像上乳腺癌在形态、边界、周围组织结构、内部回声、声影、微钙化等均有其特征性改变;彩色多普勒上乳腺癌的血流信号以2～3级为主。超声引导下定位切除的131个变中,良性病变122个,其中硬化性腺病14个,硬化性腺病伴纤维瘤形成69个,导管内乳头状瘤8个,纤维瘤24个,腺肌上皮瘤2个,腺病单纯囊肿局部性炎性3个,积乳囊肿2个;恶性病变9个,其中囊肿伴淋巴浸润癌1个,导管原位癌2个,浸润性导管癌4个,浸润性小叶癌2个。结论:乳腺不可触及肿物的超声引导下导丝定位是一种安全的方法,有助于提高乳腺良、恶性肿瘤的诊断与鉴别诊断,为临床诊断提供有价值依据。     

Family history of breast cancer, mammographic features of breast tissue, and breast cancer risk.

I reexamined the relations of family history of breast cancer in first-degree relatives, mammographic features of breast tissue, and breast cancer risk, using data from three case-control studies. Subjects included 1,047 cases with newly diagnosed breast cancer and 2,329 controls. Family history of breast cancer showed only a weak relation to mammographic features. In addition, while family history and mammographic features were each related to breast cancer risk, associations of these two factors with risk appeared additive. In contrast to previous reports, these data suggest that, to a large extent, family history and mammographic features have independent effects on breast cancer development.     

Effects of public education about breast cancer and breast self-examination

In a field experiment severity of and susceptibility to breast cancer were varied in four different persuasive messages about breast cancer and breast self-examination (BSE). The purpose of this study was to find out whether such health messages in a real-life setting had an effect on knowledge about symptoms, attitudes and behavior relating to BSE. The second goal of this study was to investigate whether fear, aroused by these persuasive communications, had a significant role in influencing the recommended behavior (BSE). In spite of a successful manipulation of seriousness and susceptibility no differences for the dependent variables could be established between the experimental groups after one month. However, differences were found by comparing the experimental groups with the no health message group. After reading the pamphlet (no matter which of the four) women showed greater intention to perform BSE regularly. This could be attributed to a higher estimation of the chance of recovery through early detection of lumps (efficacy) after reading the pamphlet. The health messages also appeared to have a positive influence on compliance with recommended behavior: women examined their breasts more in the prescribed way. An inhibiting effect of fear on behavior (which is sometimes theoretically suggested) was not found. The effects of the pamphlet that were established are formed in a more informational, cognitive way.     

Special considerations in breast cancer treatment of an augmented breast

Breast augmentation surgery involving the use of implants has been one of the most popular plastic surgical procedures for decades. As the multi-million female population who received breast implants ages, the risk of cancer is increasing rapidly, therefore the incidence of malignant disease in association with breast implants will increase as well. Although there is no relationship between tumor development and implants, these cases require special considerations in diagnostics, therapy and follow-up methods. Appropriate multidisciplinary treatment of tumors in augmented breasts corresponding with modern oncoplastic principles can only be accomplished based on adequate oncological, breast and plastic surgical knowledge. Supposing a possible increase of this condition in Hungary, too, authors provide a wide review of the literature on the special oncological and esthetic considerations, for the first time in Hungarian language.     

乳腺癌浸润相关因素分析及其在保乳手术中的应用

目的 探讨乳腺癌保乳手术距肿瘤边缘最佳的切除范围及肿瘤浸润相关因素。方法 对100例乳腺癌患者行肿瘤切除的标本分别距肿瘤边缘0．5、1．0、1．5、2．0cm处进行病理学检查，并对乳腺癌浸润与肿瘤大小、年龄、腋窝淋巴结及肿瘤分期等临床相关性进行分析。结果 100例标本中，分别于0．5、1．0、1．5、2．0cm处发现癌细胞浸润36、26、15、0例，肿瘤浸润距离与肿瘤大小呈正相关，与年龄呈负相关，与肿瘤分期（I、Ⅱ期）无明显相关性。0．5cm浸润距离的腋窝淋巴结阳性率较高，大于1．0cm的浸润距离与腋窝淋巴结状态无相关性。结论 乳腺癌行保乳手术的切除范围至少应为距离肉眼可见肿瘤边缘2．0cm的癌旁组织织。     

乳腺癌浸润相关因素分析及其在保乳手术中的应用

目的探讨乳腺癌保乳手术距肿瘤边缘最佳的切除范围及肿瘤浸润相关因素。方法对100例乳腺癌患者行肿瘤切除的标本分别距肿瘤边缘0.5、1.0、1.5、2.0cm处进行病理学检查,并对乳腺癌浸润与肿瘤大小、年龄、腋窝淋巴结及肿瘤分期等临床相关性进行分析。结果100例标本中,分别于0.5、1.0、1.5、2.0cm处发现癌细胞浸润36、26、15、0例,肿瘤浸润距离与肿瘤大小呈正相关,与年龄呈负相关,与肿瘤分期(Ⅰ、Ⅱ期)无明显相关性。0.5cm浸润距离的腋窝淋巴结阳性率较高,大于1.0cm的浸润距离与腋窝淋巴结状态无相关性。结论乳腺癌行保乳手术的切除范围至少应为距离肉眼可见肿瘤边缘2.0cm的癌旁组织。