乳管镜定位下乳腺导管内病变切除术的临床应用

目的:探索乳管内窥镜(fiberopfic ductoscopy,FDS)定位下对乳腺导管内新生物切除的可行性并总结经验.方法:分析我院2004年9月～2006年11月间FDS检查的548例乳头溢液病例资料,并选择乳管镜发现导管内新生物手术的病例,对镜下乳管内新生物的图象特征、诊断、手术方式和术后病理进行分析.结果:548例乳头溢液病例中,FDS下诊断乳管内新生物187例(34.1%),其中乳管内乳头状瘤159例(29.0%),外周乳头状12例(2.2%),乳腺癌16例(2.9%).13例在我院接受手术治疗,91例在FDS定位下再行肿瘤切除或区段切除手术,44例按常规经溢液乳管内注射染料美蓝,再行选择性区段切除.FDS定位下手术组FDS诊断符合率97.8%(89/91),明显高于传统手术组86.4%(38/44)(x2=6.96,P=0.008).结论:FDS不仅是诊断乳腺导管内新生物的可靠方法,而且可以帮助手术中定位切除乳腺导管内新生物.

Breast intraductal lesion resection under breast fiberoptic ductoscopy

OBJECTIVE: To explore the feasibility and to sum up the experience of breast intraductal neoplasm resection under breast fiberoptic ductoscopy (FDS). METHODS: FDS was performed on 548 patients with nipple discharge from Sep.2004 to Nov.2006. The clinical data of breast intraductal neoplasm found by FDS in patients who underwent tumor resection were analyzed, and the breast intraductal neoplasm image characteristics, diagnosis, operative type and postoperative pathological results were analyzed. RESULTS: Of the 548 patients with nipple discharge, intraductal neoplasm was found in 187 cases (34.1%), intraductal papilloma in 159 cases (29.0%), intraductal papillomatosis in 12 cases (2.2%), and breast carcinoma in 16 cases (2.9%). One hundred thirty-five patients were operated on in our hospital, of whom 91 were performed tumor resection or segmentectomy under the localization by FDS, and the other 44 were performed segmentectomy after breast duct infusion of methylene blue. The diagnostic rate under FDS in the FDS group (97.8%) was higher than that in the breast duct infusion methylene group (86.4%) (chi2=6.96, P=0.008). CONCLUSION: FDS is not only an accurate diagnosis for breast intraductal lesion, but also an assistance to localize the breast intraductal neoplasm and to remove them in the operation.