经乳腺后间隙入路行乳腺肿块微创旋切活检的临床分析

目的：探讨经乳腺后间隙入路 Mammotome 微创手术行乳腺肿块活检的临床价值。方法将2011年1月至2012年5月在我院乳腺科行 Mammotome 微创手术的787例患者应用计算机随机分为两组，行乳腺后间隙入路 Mammotome 微创手术385例，乳腺肿块旁入路402例。术后常规随访，分别比较两组患者的手术效果及并发症情况。结果术后随访12个月，乳腺后间隙入路组和肿块旁入路组手术时间分别为（48±6）min 和（52±4）min，肿瘤切除率分别为99.48％（383/385）和99.25％（399/402），组间比较差异无统计学意义（P 均＞0.05）；两组术中出血量分别为（8±3）ml 和（14±6） ml，术后皮下瘀斑发生率分别为2.34％（9/385）和8.71％（35/402），残腔血肿发生率分别为0.52％（2/385）和2.74％（11/402），切口数量分别为（1.3±0.6）个和（2.4±0.3）个，组间比较差异均有统计学意义（P =0.033，P =0.000，P =0.001，P =0.006），两组患者满意率分别为98.70％（380/385）和89.30％（359/402），乳腺后间隙入路组高于肿块旁入路组，组间比较差异有统计学意义（ P =0.004）。结论乳腺后间隙入路 Mammotome 微创活检乳腺肿块较常规乳腺肿块旁入路微创手术方式出血性并发症少，美观效果更佳，有一定的优势。

The clinical analysis of ultrasound-guided Mammotome resection of breast lumps through the retromammary space

Objective To evaluate the effect of ultrasound-guided vacuum-assisted minimal invasive resection（Mammotome procedure）of breast lumps through the retromammary space. Methods Seven hundred and eighty-seven patients in Obstetrics and Gynecology Hospital Affiliated to Fudan University from Jan. 2011 to May 2012 were underwent ultrasound-guided Mammotome operation through the retromammary space （retromammary space group,385 cases）,or adjacent the lumps,and followed by post-operation visits regularly （Mammotome operation adjacent the lumps group,402 cases）. The operation effects were compared between the two groups. Results All cases were followed up for 12 months. The period of Mmmotome operation through the retromam mary space and the rate of resection were（48 ± 6）min and（52 ± 4）min,99. 48%（383 / 385）, 99. 25%（399 / 402）,perspectively,in group of Mammotome operation through the retromammary space and Mammotome operation adjacent lumpsand. There was no significant difference between the two groups（ P〉 0. 05）. The amount of procedural bleeding,the incidence of ecchymosis,local hematoma and the number of incision in group of Mammotome operation through the retromammary space were（8 ± 3）ml,2. 34%（9 / 385）, 0. 52%（2 / 385）,（1. 3 ± 0. 6）respectively,which were significantly lower than those in Mammotome operation adjacent the lumps group（（14 ± 6）ml,8. 71%（35 / 402）,2. 74%（11 / 402）,（2. 4 ± 0. 3）respectively）. There were statistical difference between two groups（ P = 0. 003,P 〈 0. 001,P = 0. 001,P = 0. 006）. The rate of satisfaction in group of Mammotome operation through the retro-mammary space was 98. 70%（380 / 385）,which is significantly higher than in group of Mammotome operation adjacent the lumps（89. 30%（359 / 402）,P〈 0. 01）. Conclusion The therapy approach of ultrasound-guided Mammotome operation through the retromammary space has lower hemorrhagic complication,as well as the better effect with special advantages. Therefore it has prospective clinical application.