乳晕边缘小切口切除乳房多发或巨纤维腺瘤

目的探索采用乳晕边缘小切口切除乳房多发或巨大良性纤维腺瘤,达到既切除病灶又能起到美容目的的可行性。方法2006年1月～2008年2月选择46例乳房多发良性纤维腺瘤和2例巨纤维腺瘤（〉7cm）,根据多数肿瘤或巨大肿瘤存在的部位,选择不同象限的乳晕边缘切口,切口长度不超过乳晕周长的1/2。对于多发乳房良性肿瘤,在皮下脂肪和腺体之间潜行游离到肿瘤表面,放射状切开肿瘤表面的腺体,将肿瘤完整切除;对于巨大良性肿瘤,同法切开腺体至肿瘤表面,将肿瘤分块全部切除。结果46例多发乳房纤维腺瘤共计切除肿瘤165个,其中1例双侧乳房肿瘤数量达19个,均完整切除;乳房巨纤维腺瘤2例,肿瘤最大直径8cm,也将肿瘤完整切除。乳晕边缘切口长度〈3.5cm,术后均未发生乳头坏死。48例随访1～24个月,平均14.4月,11例切口瘢痕不明显,26例注意观察才能发现切口瘢痕,9例比较容易看到切口瘢痕,2例因瘢痕体质切口瘢痕明显。结论乳晕边缘小切口切除乳房多发或巨纤维腺瘤,手术方法简便易行,可达到较好的美容效果,值得推广。

Periareolar Incision in the Treatment of Multiple or Giant Fibroadenoma of the Breast

Objective To explore the feasibility of lumpectomy via periareolar incision in the treatment of multiple or giant fibroadenoma of the breast to achieve good clinical and cosmetic outcomes.Methods From January 2006 to February 2008,totally 46 pateints with multiple fibroadenoma and 2 cases of giant fibroadenoma(>7 cm in diameter)of the breast were treated in our hospital by lumpectomy via a periareolar incision.The length of the incision was less than half of the perimeter of the areola.For multiple fibroadenomas,circumareolar incision(not longer than half of the nipple-areolar perimeter)was made in different quadrants according to the position of the main tumor,so that the multiple benign tumors could be integrally removed through the approach between the hypodermic fat and glands via radial incisions.Similarly,giant benign tumors were treated through the same approach,cut into pieces,and then removed.Results Totally 165 tumors were removed from the 46 patients with multiple fibroadenomas.In the resected masses,19 were from one patient,who had bilateral multiple breast tumors.The 2 patients with giant breast fibroadenoma were also cured by lumpectomy,the diameter of the largest tumor in the two was 8 cm,while the circumareolar incisions were shorter than 3.5 cm.No nipple necrosis occurred after the operation in our series.Follow-up was achieved in all of the patients for 1 month to 2 years(mean,14.4 months),during which,11 cases showed no incision scar,26 had non-notable scars,9 cases developed observable incision scars,and 2 cases had apparent scars owing to their susceptibility to scar.Conclusions Lumpectomy via minor circumareolar incision is convenient and effective for multiple or giant benign fibroadenoma of the breast with good cosmetic outcomes.