对比声学造影诊断乳头溢液性疾病

目的探讨对比声学造影在乳头溢液性疾病中的临床应用价值.方法使用两类共5种造影剂对30例乳头溢液患者行高频超声及声学造影检查,检查结果与手术病理结果比较.结果液体造影剂可扩张导管,便于观察病变.含微气泡造影剂除扩张导管外,对病变的定位指示作用强.对比声学造影前后高频超声的诊断符合率分别为60%及73.3%.结论对比声学造影可提高导管内小病变检出率,提供病变导管的详细部位、导管扩张程度,显示占位病变,为手术提供重要参考依据.     

改良箭式皮瓣乳头再造术的临床疗效观察

目的探讨改良箭式皮瓣乳头再造术的临床疗效。方法收集2018年1月至2019年10月在南京市中医院甲乳外科住院接受改良箭式皮瓣乳头再造的患者10例,对再造乳头回缩率、患者满意度及局部皮瓣并发症发生率进行评价。结果10例患者手术时间为(15.10±1.52)min,范围为13~18 min。所有患者随访时间为(14.60±1.07)个月,范围为3~24个月。乳头高度回缩率为(28.53±3.02)%,范围为23.5%~33.2%。乳头直径回缩率为(8.92±1.05)%,范围为7.1%~10.5%。患者满意度为(97.90±1.60)%,范围为96%~100%。10例患者均未出现切口愈合不良、切口裂开、皮瓣坏死等并发症。结论改良箭头式皮瓣设计简便,操作简单,疗效满意,术后并发症发生率低。     

克氏针持续牵引法治疗乳头内陷的临床效果

目的探讨应用克氏针自制S形矫正器持续牵引治疗乳头内陷的临床效果。方法局部麻醉下,以缝线或布巾钳将内陷的乳头牵出并尽量提起,用直径为0．5～1．0mm、长约10cm的克氏针横穿乳头基底部,由乳头中心向两侧各1．5cm处将克氏针分别沿顺时针方向向两侧弯曲成半环形,然后将两侧半圆环呈合页状向下折叠,将中间横贯轴撑起牵引乳头向前。术后持续佩戴本牵引装置6个月,复诊期间可通过调整折叠角度以维持牵引力度。结果用克氏针持续牵引法治疗中度、重度乳头内陷32例58侧,经初步观察治疗效果满意,牵引治疗期间未见局部感染,治疗后乳头形态自然,随访3～6个月,乳头形态稳定,未见复发。结论克氏针持续牵引法简单易行,不影响哺乳功能,矫正治疗后乳头形态自然、稳定持久。     

刺激乳头在硬膜外麻醉分娩镇痛产妇中的应用

我科2007年3月-2009年3月对硬膜外麻醉分娩镇痛的初产妇实施刺激乳头方法，有利于加强宫缩，缩短产程，减少产后阴道出血量，提高新生儿早吸吮成功率。比静滴催产素加强宫缩更加经济、安全，减少产妇的痛苦，取得了较好的临床效果，现报告如下。     

Nipple Retractor to Correct Inverted Nipples

BACKGROUND: Inverted nipples are a common problem and a challenging clinical condition to repair. Multiple methods have been reported to correct inverted nipples, most of which will destroy breastfeeding function. PATIENTS AND METHODS: We have designed a simple nipple retractor to correct inverted nipples. A total of 53 patients with 95 inverted nipples underwent an operation in which the nipples were retracted into a normal position and fixated with the nipple retractor and wires under local anesthesia. Nipple retractors were to be worn for 6 months. Postoperatively, the patients were invited to follow-up on the 1st day, the 7th day, after 1 month, 3 months and 6 months, and yearly thereafter. Wire adjustments were performed as needed. Mean follow-up was 11.9 months (range 8-18 months). RESULTS: Improvement occurred in all patients and was sustained in all cases throughout the follow-up period. The total complication rate was 5.26% (5/95). The main complications included depigmentation (2.11%, 2/95), areolar ulcer (2.11%, 2/95), and wire dislocation (1.05%, 1/95). CONCLUSION: The nipple retractor is a simple tool with which severely inverted nipples can be successfully corrected with a low complication rate. Close follow-up and careful postoperative care are important to avoid complications.     

乳腺导管造影钼/铑靶诊断乳头溢液性质的分析

目的:评估钼/铑双靶X线乳腺导管造影结果与乳头溢液性质的关系。方法:运用钼/铑双靶乳腺导管造影对300例乳头溢液患者进行照片检查。结果:乳腺癌21例(7%),乳头状瘤150例(50%),导管扩张81例(27%),炎症13例(4.3%),囊肿12例(4%),乳腺增生症14例(4.7%),阴性9例(3%)。结论:①乳头溢液是导管内乳头状瘤的特征性临床表现。②乳腺癌在血性溢液占比例最高,共18例(85.7%)。③血性、浆液性、清水样三类溢液中,乳头状瘤比例都最高,注意与乳腺癌鉴别。     

乳头乳晕区乳腺癌术后即刻乳房重建的临床探讨

目的 探讨乳头乳晕区乳腺癌术后即刻乳房重建的方法及临床应用。方法 回顾性分析天津医科大学肿瘤医院乳腺一科2004年1月至2007年12月共15例乳头乳晕区乳腺癌患者，其中0期乳腺癌3例，Ⅰ期乳腺癌7例，Ⅱ期乳腺癌5例。15例患者中13例行乳头乳晕区圆形切ISI的保乳手术（标本切缘阴性）后即刻背阔肌皮瓣重建术，2例拟行乳头乳晕区圆形切口的保乳手术，因标本切缘阳性，改行仿根治术，术后行即刻背阔肌皮瓣加假体植入乳房重建术。15例患者中即刻乳头乳晕重建术9例，延期乳头乳晕重建术2例，拒绝乳头乳晕重建4例。结果 13例保乳加背阔肌皮瓣重建患者中12例外形满意，满意率为92．31％，1例缝合后中央区内陷，外形不满意，但大小与健侧对称。2例背阔肌皮瓣联合假体重建乳房外形满意。9例即刻重建乳头乳晕7例成活，2例发生重建乳头部分坏死；3例乳头位置略高于健侧。2例延期乳头乳晕重建均成活，且位置对称。15例中6例发生背部皮下积液，1例背部切口裂开。随访10～48个月，中位随访时间25个月，1例患者出现切口局部复发，复发率为7．69％，无远处转移发生。结论 对乳头乳晕中央区乳腺癌进行保乳手术加即刻背阔肌皮瓣重建术可以提高术后乳房外形满意率，且可行即刻乳头乳晕重建术。保乳手术后局部复发率和远处转移率与根治术无差异。     

女性原发乳腺癌乳头浸润的临床病理研究

本文对1980年至1982年期间715例女性乳腺癌进行回顾性研究,病理证实乳头浸润者68例,发生率9.5%.观察研究了乳头浸润方式、浸润水平、肿瘤位置等因素的特征及其与预后的关系.乳头受浸程度分3个水平,随浸润水平的增加,10年生存率下降(P<0.05).乳头浸润方式分3种:导管浸润、间质浸润和混合形式浸润.观察到沿乳导管浸润乳头者预后优于间质浸润者的趋势.肿瘤距乳头越近,乳头受累机会越大,中央部者几无幸免,不宜行保留乳头的缩小手术.     

Routine operative breast endoscopy for bloody nipple discharge

Background Submillimeter endoscopes are now available and have been described to assist surgeons in the evaluation and management of symptomatic nipple discharge. Methods To evaluate its potential use, a microendoscope (0.9 mm Acueity) was used on all patients in a single surgeon's practice who were undergoing nipple exploration for spontaneous hemoccult positive nipple discharge. This procedure was performed at the surgical resection of the symptomatic retro-areolar duct, and 27 patients underwent the endoscopy during the period from January 2000 to August 2001. Results In 96% (26 of 27) of the patients, the endoscope was successfully introduced into the lactiferous sinus, and the proximal breast ducts were successfully visualized. A lesions accounting for the bleeding was seen in all 26 patients, with 70% (n=19) having multiple intraluminal defects. Cancers were identified in two cases (7.4%), and in both cases, there was a more proximal papilloma in the same ductal system. Similarly, in 33% of the benign cases, both papillomas and usual or atypical ductal hyperplasia were present. Lesions were identified that extended up to 7.5 cm deep to the nipple. The deepest lesions was one of the endoscopically identified cancers in a patient with normal mammogram and breast ultrasound. Surgical resection could be directed by simple transillumination of the skin during endoscopy. Conclusions This series demonstrates the clinical feasibility of routine operative breast endos-copy in the management of bloody nipple discharge. The high incidence of multiple lesion identification suggests that the classic blind resection of a limited distance of duct in the retroareolar space may significantly underestimate the true extent of proliferative disease accounting for pathologic nipple discharge.     

隆起器治疗先天性乳头凹陷畸形的临床研究

目的：总结隆起器治疗不同程度先天性乳头凹陷畸形的疗效确切性.方法：应用自行负压原理,设计带有自动阀门的大小不同隆起器,以治疗不同直径大小的凹陷畸形乳头.结果：1999至2004年应用有自行负压的乳头凹陷隆起器治疗2000例先天性乳头凹陷畸形患者,有效率100%,治愈率达99%.停止治疗后随访3个月至5年,无一复发.结论：运用乳头凹陷隆起器,无需手术即可矫正畸形,恢复正常形态,且无任何副作用.经过长达5年随访,疗效确切,无一复发.