乳腺纤维腺瘤的超声诊断及临床意义

目的 超声检查对乳腺纤维腺瘤的诊断价值和临床意义.方法 采用高频探头对30例乳腺纤维腺瘤患者的乳房肿块进行扫查,记录肿块的大小、数量、形态及内部回声等,并结合扪诊进行分析诊断.结果 30例患者中有28例与B超诊断相符合,占93.33%;肿块呈圆形或椭圆形两种形态,外上象限多发占61%;内部呈低回声占71%,回声均匀占7...     

乳腺纤维腺瘤的治疗进展

乳腺纤维腺瘤是发生于乳腺小叶内纤维组织和腺上皮的混合性肿瘤,是乳房良性肿瘤中最常见的一种。约10%的女性一生中会患该病,可发生于青春期后的任何年龄的女性,但以18~25岁的青年女性多见。具体病因尚未完全清楚,可能与体内雌激素水平升高或局部组织对雌激素的敏感性增强、基因改变、某些药物的影响、某些病毒感染等有关[1-3]。长期以来,乳腺纤维腺瘤的治疗原则是手术切除,药物治疗效果甚微。据大宗病例报告,该病恶变率甚低,约为0.038%~0.125%[4]。有学者认为,该病恶变的危险为累积性增加[5],也就是说,生长时间越长、恶变的几率越高。系统…     

乳腺纤维腺瘤并存乳腺囊性增生病配合中药治疗的临床研究

目的 探讨乳腺纤维瘤并存乳腺囊性增生时中西医结合治疗方法及评价围手术期配合中药的临床价值。方法 回顾性分析20年间86例临床资料，单行瘤体连同增生组织整块切除42例（传统组），围手术期配合中药择期行瘤体局灶切除44例（改进组），两组术前术后进行比较研究。结果 两组采用不同方法均达到全部治愈效果，改进组仅施行瘤体局灶切除，其创伤、技术难度及术后乳房外形明显优于传统组，两组比较差异有显著性（P〈0．01）。结论 本研究解决了因整块组织切除并大部分需行乳房重建问题，最大限度保留了乳腺组织，降低了手术创伤与技术难度，变较大手术为较小手术，不再需要乳房蓖建整形，对青年女性尤其重要，临床实用价值较高。     

乳腺多发性纤维腺瘤的腔镜治疗

目的探讨腔镜治疗乳腺多发性纤维腺瘤的可行性。方法经超声检查结合细针细胞学检查诊断乳腺多发性纤维腺瘤12例。选择腋窝小切口入路,钝性分离乳腺后间隙,充气建立乳腺后间隙手术气腔,腹腔镜下切除共58个纤维腺瘤,术中冰冻切片。结果12例肿瘤均在腹腔镜下成功切除,无手术并发症。手术时间40~150min,平均80min。术后1个月乳房形态良好,乳头感觉正常。12例术后随访1~36个月,平均18.5月,乳房表面无瘢痕,无肿瘤复发,患者对美容效果满意。结论经乳腺后间隙入路,腔镜治疗乳腺多发性纤维腺瘤是一种安全、可行的治疗方法。     

乳腺叶状囊肉瘤和巨纤维腺瘤诊治体会(附17例报告)

目的探讨乳腺叶状囊肉瘤和巨纤维腺瘤的诊断和治疗。方法回顾分析我院1985~2002年期间外科收治的9例乳腺叶状囊肉瘤和8例乳腺巨纤维腺瘤的临床资料。结果9例乳腺叶状囊肉瘤中行单纯乳房切除术4例,保留乳头皮下乳房切除术1例,保留乳头和部分压缩腺体 肿块切除术1例,改良根治术3例;术后恢复良好,仅1例复发。8例乳腺巨纤维腺瘤中行单纯乳房切除术2例,保留乳头皮下乳房切除术1例,保留乳头和部分压缩腺体 肿块切除术2例,单纯乳腺肿块切除术3例;术后恢复良好,术后2例复发。结论乳腺叶状囊肉瘤和巨纤维腺瘤临床上均表现为无痛性包块,除乳腺叶状囊肉瘤发病年龄较大、肿块范围大及易恶变外,二者主要依据病理检查结果相鉴别;均以手术治疗为主,根据患者年龄、肿块大小以及病理检查结果选择不同的手术方式。     

重视乳腺囊性增生病的诊治

乳腺囊性增生病 (cystichyperplasiaofbreast) ,也称慢性纤维囊性乳腺病 (chronicfibrocysticdiseaseofbreast) ,简称乳腺病 (mastopathy)。本病与内分泌功能紊乱密切相关 ,本质上是一种生理增生与复旧不全所造成的乳腺结构紊乱症。为此 ,WHO命名为良性乳腺结构不良。一般估计 ,城市妇女中每 2 0个就有 1个于绝经期前可能在临床上出现乳腺病。本病近年来受到广泛注意 ,不仅因为它的发病率高 ,且易与乳腺癌混淆 ,甚至被认为是癌变的危险因素之一。不言而喻 ,加强临床上对乳腺的癌前疾病、癌前病变和原位癌的筛选 ,实际上对乳腺癌的“三早”…     

乳腺纤维腺瘤诊治专家共识

正乳腺纤维腺瘤是常见的乳腺良性疾病,自然病程较长,确诊依据病理学检查,处理方法包括随访观察和外科干预。目前国内外对纤维腺瘤的处理方法选择标准不一,缺乏统一的诊疗规范。中华预防医学会妇女保健分会乳腺保健与乳腺疾病防治学组组织国内部分专家编写《乳腺纤维腺瘤诊治专家共识》,期望能对乳腺纤维腺瘤的诊断与治疗起到一定的指导和参考作用。     

Mammotome切除乳腺纤维腺瘤的临床应用

目的探讨Mammotome切除乳腺纤维腺瘤的价值。方法对我院2006年12月至2008年3月期间超声诊断为乳腺纤维腺瘤的107例患者共129枚病灶行超声引导下Mammotome旋切术。结果 129枚肿瘤超声显示完整切除,肿物切除时间5~40 min,平均16 min。1例发生血肿,3例皮下瘀血,2例乳头溢血,无一例感染。2例皮肤切割者以创可贴拉合后2 d愈合。病理结果显示124枚为良性病变,5枚为恶性。年龄≥40岁者共20例,其中恶性3例。超声显示有钙化灶者共6枚,其中3枚为恶性。103例获门诊随访,随访时间2~12个月,平均5个月,超声发现2例复发。结论 Mammotome切除乳腺纤维腺瘤可同时达到诊断及治疗目的 ,美容效果好,对≥40岁及伴有钙化者要警惕恶性病变。     

右腹股沟区副乳腺纤维腺瘤1例报告

病人女性,52岁。因右腹股沟区渐大肿物4个月余于2010-12-28入院。4个月前病人无意间发现右侧腹股沟有一花生米粒大小的肿物,无明显的疼痛感及其他不适,未行任何治疗。4个月间肿物缓慢增大至红枣大小,触之有痛感,遂来我院就诊。查体:右侧腹股沟区皮下触及一肿     

高强度聚焦超声治疗乳腺纤维腺瘤临床初步观察

目的 对高强度聚焦超声(high intensity focused ultrasound，HIFU)治疗乳腺纤维腺瘤的疗效进行评价。方法 回顾性分析我科收治的24例乳腺纤维腺瘤患者的治疗资料。结果 HIFU治疗术后恢复快。平均于术后1.5d出院，无并发症发生；术后随访3～12个月，有2例患者乳房包块消失，5例包块不同程度缩小，未消失包块针吸活检显示为坏死组织。结论 HIFU治疗乳腺纤维腺瘤较为安全、有效，既能保持乳房外形美观,又不损害乳房功能，具有良好的应用前景。     

Progressive adoption of cryoablative therapy for breast fibroadenoma in community practice

BACKGROUND: Cryoablation is a recent technological advance and has been used for the percutaneous treatment of breast fibroadenomas. Herein, we provide a retrospective summary of the early experience from a nationwide group. METHODS: We organized a national registry to document the community practice and adoption of an office-based system of cryoablation for breast fibroadenoma. Data were abstracted during the first 6 weeks after the procedure to assess acute outcome and potential complications. At 6-and 12-month follow-up intervals, additional data were collected regarding fibroadenoma resolution, cosmesis, and patient satisfaction. RESULTS: Fifty-three sites ablated 310 fibroadenomas. Early follow-up data on 256 lesions showed that the procedure was well tolerated with infrequent minor complications immediately after the procedure. At 6 and 12 months postprocedure, the remaining fibroadenoma volume progressively involuted. At both intervals, cosmesis was excellent, and patient satisfaction was rated high. CONCLUSIONS: An early community experience with office-based cryoablation of breast fibroadenomas is encouraging and comparable to the initial experience of high-volume tertiary centers. More follow-up is necessary to determine long-term results and residual mammographic changes.     

乳腺纤维腺瘤手术治疗进展

乳腺纤维腺瘤是女性乳腺最常见的良性肿瘤,多发生在30岁以下的年轻女性,临床以手术切除为主要的治疗手段,手术方法和时机的选择受患者年龄、生育需求、肿瘤大小、位置等诸多因素的影响。考虑到年轻女性爱美之心以及将来哺乳的要求,结合美容医学技术的进展选择更为患者接受的术式显得尤为重要。乳腺纤维腺瘤治疗的手术方法较多,效果不一,适用对象也有差异,本文就乳腺纤维腺瘤的手术进展以及手术时机的选择进行综述。     

多中心性乳腺导管内癌的诊疗分析

目的 探讨多中心性乳腺导管内癌的临床特点,以期提高早期诊断率.方法 回顾性分析华中科技大学同济医学院附属协和医院乳腺甲状腺外科2003年9月-2009年2月收治的23例多中心性乳腺导管内癌患者的临床资料.结果 本组患者中4例伴有乳头溢液,18例术前体检无阳性发现(78%).在术前半年内的检查中,钼靶摄影的阳性率为90%,主要特点是存在弥漫性和多发性的细小钙化;MRI的阳性率为25%,B超无阳性发现.经术中冰冻切片检查证实多中心性乳腺导管内癌后,均接受了全乳切除和同侧腋窝L1、L2组淋巴结清扫术治疗.结论 钼靶摄影发现弥漫性和多发性的细小钙化是多中心性乳腺导管内癌的早期表现之一,该疾病虽然病变范围广泛但仍属早期肿瘤,经综合治疗后预后良好.

Abstract：

Objective To investigate clinical characteristics of the multi-center breast DCIS (ductal carcinoma in situ), in order to improve the rate of early diagnosis. Methods Clinical data of 23 multi-center breast DCIS patients admitted and operated on from September 2003 to February 2009 at our department were retrospectively reviewed. Results There were 4 cases associated with nipple discharge,and 18 cases with preoperative negative physical examination (78%). In the preoperative examination within 6 months, the positive rate of mammography was 90% mainly characterized by the existence of diffuse and multiple small calcifications. The positive rate of MRI was 25%, B ultrasound had no positive findings. The patients that were confirmed multi-center breast DCIS by intraoperative frozen section examination received mastectomy and ipsilateral axillary L1, L2 lymph node dissection. Conclusion The diffuse and multiple small calcification is one of early clinical characteristics of multi-center breast DCIS. Although the disease has a wide range of lesion, it still is an early tumor, and has a favourite prognosis after comprehensive treatment.     

Ultrasound-guided, vacuum-assisted excision in the diagnosis and treatment of clinically benign breast lesions

INTRODUCTION

Ultrasound-guided, vacuum-assisted biopsy has a definitive role in the diagnosis of breast lesions. Its role in the treatment of benign breast lesions like fibroadenomas has not been established.

PATIENTS AND METHODS

This is a retrospective review of patients undergoing ultrasound-guided, vacuum-assisted biopsy for clinically benign breast lesions. The procedures were performed in all cases by two consultant radiologists with special interest in breast radiology between February 2002 and January 2004. Patients were followed up in the clinic 6 weeks after the procedure.

RESULTS

Seventy-six patients had ultrasound-guided, vacuum-assisted excision of clinically benign breast lesions during this 2-year period. Mean age of the patients was 31 years. Altogether, 86 procedures were performed. Six patients with larger lesions (> 2 cm) had two procedures on separate sitting and 4 patients had separate lesions excised on a later date. Fifty-six patients were identified to have fibroadenomas and had complete excisions as evidenced on scan. Three out of nine patients identified with equivocal disease on fine needle aspiration cytology (FNAC) were found to have cancer following ultrasound-guided, vacuum-assisted excision. One patient who was diagnosed with cancer on FNAC, proved to be fibroadenoma on final histopathology. Four patients developed haematomas following ultrasound-guided, vacuum-assisted excision and all were managed conservatively.

CONCLUSIONS

Our study shows that ultrasound-guided, vacuum-assisted excision can play an efficient role in the diagnosis of benign breast lesions and is a safe and successful alternative in treatment of fibroadenomas.     

Percutaneous removal of benign breast masses using a vacuum-assisted hand-held device with ultrasound guidance

BACKGROUND: This study evaluates the safety, efficacy, and patient acceptance of a vacuum-assisted, hand-held biopsy device (Mammotome) in percutaneous removal of breast masses using ultrasound guidance. METHODS: A multicenter, nonrandomized study evaluated 124 women with low-risk palpable lesions. Lesions 1.5 cm but 相似文献   

隐匿性乳腺癌的诊断与治疗

目的探讨隐匿性乳腺癌(OBC)的诊断与治疗经验。方法回顾性分析13例隐匿性乳腺癌的诊断与治疗方法。结果 10例腋窝肿块免疫组化,7例雌激素受体(ER);病理切片淋巴结转移性腺癌。乳腺癌根治或改良根治术后标本全乳房多次连续病理切片,3例未见原发灶,10例找到直径0.15 cm～0.90 cm肿瘤。5 a生存率46.15%。结论腋窝淋巴结活检、免疫组化分析及MRI检查对隐匿性乳腺癌的诊断具有重要意义,治疗首选改良根治术并辅以化疗、放疗及内分泌治疗等综合治疗。     

复杂性腹膜后节细胞神经瘤的诊断与治疗

腹膜后节细胞神经瘤是一种罕见的神经源性良性肿瘤,行手术彻底切除,预后良好,但手术难度较大.2013年3月重庆医科大学附属第一医院收治1例复杂性腹膜后节细胞神经瘤患者,入院前9个月彩色多普勒超声检查发现胰头部低回声包块影,大小为6.5 cm×4.5 cm,无任何临床症状.术前腹部CT检查及术中发现肿瘤大小为8.5 cm×7.5 cm×4.5 cm,位于胰腺后方,包绕腹腔干、肝总动脉、脾动脉及肠系膜上动脉等重要血管,包绕胰头部及钩突部,无法分离;与门静脉、肠系膜上静脉、脾静脉、左肾静脉关系密切.术中将肿瘤与各重要血管及胰腺体尾部分离、解剖,但肿瘤与胰头部无法分离,遂行肿瘤切除及胰十二指肠切除术.虽手术难度大,但肿瘤切除彻底,重要血管得到保护,患者术后恢复良好.     

Low-risk palpable breast masses removed using a vacuum-assisted hand-held device

BACKGROUND: This study evaluates the safety, efficacy, and patient acceptance of a vacuum-assisted, hand-held biopsy device (Mammatome) in the percutaneous removal of breast masses using ultrasound guidance. METHODS: A multicenter, nonrandomized study evaluated 216 women with low-risk palpable lesions. Lesions 1.5 to 3.0 cm in size were removed using an 8-gauge probe. Those lesions <1.5 cm were removed with the 11-gauge probe. Follow-up evaluation was performed at 10 days and 6 months after biopsy. RESULTS: A total of 127 patients had biopsies using the 8-gauge probe, and 89 patients had biopsies using the 11-gauge probe. At 6-month follow-up, 98% of the lesions remained nonpalpable, 73% with no ultrasonographically visible evidence of the original lesion. Most complications were mild and anticipated. Most patients (98%) were satisfied with incision appearance, and 92% of patients would recommend the procedure to others. CONCLUSIONS: Percutaneous removal of palpable benign breast masses using the Mammotome system is feasible and safe, and yields high patient satisfaction. The results at 6 months after biopsy demonstrated the effectiveness of benign lesion removal, with correlative clinical data demonstrating lack of palpability and no need for additional procedures. Continuing evaluation of long-term efficacy is ongoing.     

When pathological and radiological correlation is achieved,excision of fibroadenoma with lobular neoplasia on core biopsy is not warranted

BackgroundThe diagnosis and management of lobular neoplasia (LN) including lobular carcinoma in situ (LCIS) and atypical lobular hyperplasia (ALH) remains controversial. Current management options after a core needle biopsy (CNB) with lobular neoplasia (LN) incorporating both ALH and LCIS include excision biopsy or careful clinical and radiologic follow up.MethodsA retrospective analysis of the surgical database at Cork University Hospital was performed to identify all core needle biopsies from January 1st 2010 to 31st December 2013 with a diagnosis of FA who subsequently underwent surgical excision biopsy. All cases with associated LN including ALH and classical LCIS were selected. We excluded cases with coexistent ductal carcinoma in situ (DCIS), invasive carcinoma, LN associated with necrosis, pleomorphic lobular carcinoma in situ (PLCIS) or lesions which would require excision in their own right (papilloma, radial scar, atypical ductal hyperplasia (ADH) or flat epithelial atypia (FEA)). Cases in which the radiologic targeted mass was discordant with a diagnosis of FA were also excluded.Results2878 consecutive CNB with a diagnosis of FA were identified. 25 cases had a diagnosis of concomitant ALH or classical LCIS. Our study cohort consisted of 21 women with a mean age 53 years (age range 41–70 years). The core biopsy diagnosis was of LCIS and FA in 16 cases and ALH and FA in 5 cases. On excision biopsy, a FA was confirmed in all 21 cases. In addition to the FA, residual LCIS was present in 14 cases with residual ALH in 2 cases. One of the twenty-one cases (4.8%) was upgraded to invasive ductal carcinoma on excision.     

乳腺癌术后乳糜漏的诊治分析

目的探讨乳腺癌术后乳糜漏的诊断及治疗方法,为该病提供有效治疗方法。方法回顾性分析1997年6月至2013年8月收治6例乳腺癌术后并发乳糜漏的诊治经过。结果 1例保守治疗治愈。5例行手术治疗,1例治愈,4例术后仍有乳糜漏,采用碘仿纱填塞漏口加压包扎、负压引流治愈。结论术中熟悉腋窝的解剖关系、彻底结扎淋巴管可以减少乳糜漏发生。禁食营养支持治疗、局部加压包扎、碘仿纱填塞和负压引流是治愈乳腺癌术后乳糜漏的有效方法。