彩色多普勒超声引导下亚甲蓝边界定位法在乳腺癌保乳手术中的应用价值

目的探讨术前彩色多普勒超声引导下应用亚甲蓝定位肿瘤边界在乳腺癌保乳手术中的效果。方法收集2015年5月至2017年12月拟行保乳手术的乳腺癌患者120例,随机分为观察组和对照组各60例。观察组术前在彩色多普勒超声引导下行亚甲蓝定位,对照组采用传统手术方法。所有标本切除后进行病理检查,统计两组切缘情况。从精准性及微创性两方面比较两种方法的手术效果。结果观察组中,3例(5.0%)最大切缘>2 cm,57例(95.0%)最大切缘≤2 cm;对照组中,31例(51.7%)最大切缘>2 cm,29例(48.3%)最大切缘≤2 cm。两组比较差异有统计学意义(P=0.000)。观察组6例(10.0%)患者的手术标本镜下切缘阳性,54例(90.0%)切缘阴性;对照组15例(25.0%)镜下切缘阳性,45例(75.0%)切缘阴性。两组比较差异有统计学意义(P=0.031)。观察组和对照组分别有2例和3例在行二次扩切后切缘仍为阳性,改行乳腺全切手术。结论采用术前彩色多普勒超声引导下亚甲蓝定位肿瘤边界指导乳腺癌保乳手术的方法较常规方法在手术精准性及微创性两方面均有优势。

Application value of color Doppler guided methylene blue boundary location method in breast-conserving surgery for breast cancer

Objective To explore the application effect of methylene blue labeled breast tumor boundary under the guidance of color Doppler ultrasound before surgery in breast-conserving surgery.Methods From May 2015 to December 2017,120 cases of breast cancer patients planned to undergo breast-conserving surgery were randomly divided into observation group and control group with 60 cases in each group.Patients in observation group were positioned with methylene blue guided by color Doppler ultrasound before surgery,while the patients in control group were treated with traditional surgical methods.All specimens were dissected after resection,and the resection margins of the two groups were compared.The surgical effects of the two methods were compared in terms of accuracy and minimally invasiveness.Results In observation group,3 cases(5.0%)with the maximum resection margin>2 cm,and the index of 57 cases(95.0%)was≤2 cm.In control group,the maximum resection margin of 31 patients(51.7%)was>2 cm,and that in 29 cases(48.3%)was≤2 cm.The difference between the two groups was statistically significant(P=0.000).In observation group,6 cases(10.0%)had positive resection margin under microscope,and 54 cases(90.0%)had negative resection margins.In control group,15 cases(25.0%)had positive resection margins under microscope,and 45 cases(75.0%)had negative resection margins.The difference between the two groups was statistically significant(P=0.031).After the second enlarged resection,the margins of 2 cases in observation group and 3 cases in control group were still positive,and then total breast resection was performed.Conclusion Under the guidance of preoperative color Doppler ultrasoun,the application of methylene blue for breast tumor boundary location in breast-conserving surgery has advantages over traditional methods in terms of surgical precision and minimally invasiveness.