超声引导下Encor真空辅助乳腺微创旋切治疗乳腺良性结节的并发症分析及对策

目的探讨超声引导下Encor真空辅助乳腺微创旋切治疗720例乳腺良性结节的相关并发症及防治对策。方法回顾分析徐州医科大学第二附属医院甲乳外科2015年5月～2019年1月微创旋切手术720例乳腺良性结节住院患者。术后于1周、3个月、6个月、1年时门诊随访,评估术后血肿、淤青、皮肤凹陷、切口疼痛、切口愈合等并发症及患者满意度,复查乳腺彩超有无结节残留或复发。结果术后活动性出血2例(0.28%),经抽吸、重新加压包扎痊愈;术后1周47例(6.53%)有可触及血肿,经局部热敷1～6个月均消失;皮下淤青103例(14.31%),未做特殊处理,1～2周完全消退;术中皮肤切破2例(0.28%),缝合处理;局部皮肤严重凹陷1例(0.14%),经小针刀皮下分离黏连后外观恢复正常;术后半年复查局部残留11例(1.53%),9例再次行旋切手术,2例经开放切除,之后随访1年均无再复发;患者满意度高达98.20%;无刺伤胸膜引起血气胸病例。结论乳腺微创旋切治疗乳腺良性结节有一定的术中、术后并发症发生率,大部分并发症发生于开展初期3个月内,后随着手术技巧改进及相关防范措施的完善,可明显减少并发症的发生。

Complications and countermeasures of Encor vacuum-assisted minimally invasive rotary mastectomy for benign breast nodules under ultrasound guidance

Objective To investigate the related complications and preventive measures of Encor vacuum-assisted minimally invasive rotary mastectomy under ultrasound guidance in the treatment of 720 benign breast nodules.Methods 720 inpatients with benign breast nodules undergoing minimally invasive rotary incision from May 2015 to January 2019 in the Second Affiliated Hospital of Xuzhou Medical College were retrospectively analyzed.Postoperative followup visits were performed at 1 week,3 months,6 months,and 1 year after the operation.The postoperative complications such as postoperative hematoma,bruise,skin depression,incision pain and incision healing,and patients'' satisfaction were evaluated.The breast color Doppler ultrasound was reviewed to check whether there was nodule residue or recurrence.Results There were 2 cases of postoperative active bleeding(0.28%),and they were cured after aspiration and recompression bandage.47 cases(6.53%) had palpable hematoma one week after operation,and all of them disappeared by local hot compress for 1-6 months.There were 103 cases of subcutaneous bruising(14.31%),without special treatment,and they were completely subsided in 1-2 weeks.2 cases(0.28%) of the skin were cut and sutured during the operation.1 case(0.14%) had severe skin sag,and the appearance returned to normal after subcutaneous separation with a small needle.Reexamination at 6 months after the operation found 11 cases(1.53%) of local residuals.9 patients underwent rotary mastectomy again,and 2 cases were treated with open resection.There was no recurrence after one year follow-up.The patient satisfaction rate was as high as 98.20%.No hemopneumothorax cases caused by stabbing pleura were found.Conclusion There is a certain incidence of intraoperative and postoperative complications of minimally invasive rotary mastectomy in treatment of benign breast nodules.Most complications occur within 3 months of the initial stage of development.With the improvement of surgical techniques and the improvement of relevant preventive measures,the complications can be significantly reduced.