【Abstract】ObjectiveTo introduce the minimally invasive excision and biopsy of breast neoplasm with Mammotome vacuum device guided by ultrasound. MethodsFiftytwo breast masses were detected in 30 patients through color Doppler. The ages of these patients range from 18 years to 49 years. Forty-six of those masses (88.5%) were clinically impalpable. Complete excision and biopsy of 52 breast masses were performed using Mammotome vacuum device guided by ultrasound. The patients were followed up and their postoperative condition were recorded. ResultsFiftytwo breast masses of 30 cases were excised completely, which was verified by color Doppler.The tissue excised by Mammotome were enough for pathological examination. Fortysix masses were proved to be fibroadenoma and the other 6 were proved to be adenosis. Hematoma was found in four patients after operation. The incisions were small and hidden, and the appearance of breasts remained well. Twenty patients were followed up for a shot period of time and no residual nidus or recurrence of the mass was found.ConclusionMinimally invasive excision and biopsy of breast masses with Mammotome vacuum device is an accurate and safe method. It is an ideal minimally invasive operation in treating benign breast neoplasm with few complications. It can be applied to biopsy of breast masses and complete excision of benign breast masses which are less than 2 cm in the same time.
探讨超声引导下Mammotome微创旋切系统对乳腺病灶进行微创切除的治疗价值。方法:在超声图像监控下,利用Mammotome 系统对680例1900个乳腺肿块进行切除及病理检查,并记录术后随访情况。对其进行回顾性分析,评价其在乳腺微创外科的应用价值。结果:680例1900个乳腺肿块被准确地完全切除,切除组织量大,足够用于病理诊断,术后病理学诊断1例为恶性,其余均为良性。1175个肿块为纤维腺瘤,661个肿块为纤维腺病,19个肿块为导管内乳头状瘤,42个肿块为囊肿及囊性增生,2个肿块为管状腺瘤,1个肿块为乳腺小管癌。术后每3~6个月定期接受复查,术后切口小而隐蔽,瘢痕不明显, 乳腺外形及皮肤感觉正常,超声未发现病灶残留,复发。结论:Mammotome技术对乳腺病灶可进行完整切除,是准确、有效、安全、美观、值得推广的乳腺微创技术。
Objective To discuss the surgical indication of mammotome （MMT） operation and its auxiliary diagnosis value on breast cysts. Methods Seventy-eight patients with breast cysts from May 2010 to November 2011 in this hospital were enrolled. Excision and biopsy were performed according to the following guidelines：Single cyst with inhomogeneous interna echoes and diameter at least 1 cm；Multiple cysts associated with irregular megalgia， localized thickening of breast or ineffective drug treatment after three months；High risk of breast cancer；Hypoechoic nodules and laticifers exaggerated cysts；Ultrasonography showed disorderly echo and abundant blood supply in glandular tissues around the lesions. The result of preoperative ultrasound was compared with that of postoperative pathology diagnosis. Results In these 78 breast cysts patients with preoperative ultrasound diagnosis， 40 cases were breast multiple cysts， 38 cases were multiple cysts plus untouchable hypoecho nodules；42 cases were high risk lesions， and the other 36 cases were low risk lesions. Postoperative pathology diagnosis revealed 27 cases of cystic hyperplasia， 2 cases of atypical hyperplasia， and 1 case of breast cancer in the ultrasonic high risk lesions， and 19 cases of cystic hyperplasia in the ultrasonic low risk lesions. Ultrasound diagnostic accuracy rate was 60.26%（47/78）， sensitivity was 61.22%（30/49）， and specificity was 58.62%（17/29）. The number of resection lesions was 13.00±8.16， the time of operation was （74.25±22.68） min. The average hospital stay was 1 d after surgery. The local hematoma occurred in 2 cases and no other complications occurred during one month of follow-up. Conclusions The guidelines of MMT protocoled according to clinical manifestation of breast cyst patients and imaging of high-frequency ultrasound in author’s department are simple and utility. Minimal excision and biopsy via MMT can confirm the histological type and help for early diagnosis of breast cancer and precancerous lesion. It is important and necessary to standardize the surgical indications of MMT in the clinical work.
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。
【摘要】目的探讨超声导向下Mammotome活检及旋切系统切除乳腺肿块的并发症及其处理。方法在超声导向下，利用Mammotome系统对乳腺肿块进行活检和切除，对出现的并发症进行及时的处理。结果46例患者的75个乳腺肿块被切除，病理证实68个为纤维腺瘤，7个为纤维腺病。术中并发症包括出血、血肿和胸大肌损伤，经及时处理后恢复，术后并发症为瘢痕形成。结论Mammotome乳腺肿块切除术具有创伤小、并发症少的优点，是一种有效的、不影响乳房外观的微创手术，超声监控能够减少和发现并发症并进行正确的处理。
ObjectiveTo explore the therapeutic value of ultrasound-guided minimally invasive Mammotome system for mammary glands nodules without type-B ultrasound echo. MethodsBetween May 2009 and April 2014, 95 patients with mammary glands nodules without type-B ultrasound echo accepted B-ultrasound guided mammotome rotary cutter excision. ResultsPreoperative B ultrasound showed single shot without echo in 30 cases and multiple shot without echo in 65 cases. Among the 95 cases without echo, there were 23 cases of mixed echo nodules, and 25 cases of clustered echo-free nodules. The postoperative pathological diagnosis showed non-proliferative fibrocystic changes in 78 cases, proliferative fibrocystic changes in 17 cases (including 1 case of carcinoma in situ), and 3 cases of intraductal papilloma. ConclusionUltrasound-guided minimally invasive Mammotome system is a choice for treating mammary glands nodules without type-B ultrasound echo.
Objective To explore the risk factors of perioperative insomnia in young patients with breast masses undergoing ambulatory Mammotome (MMT) minimally invasive surgery. Methods A total of 166 young female patients who were ≤40 years old, diagnosed with breast masses, undergoing ambulatory MMT between June and December 2016 in West China Hospital of Sichuan University were included in this study. Questionnaire survey and data about general condition, preoperative and postoperative Insomnia Severity Index (ISI), Hospital Anxiety and Depression Scale, and postoperative pain Visual Analogue Scale were collected in the enrolled population. Univariate analysis was used to screen the factors that might cause insomnia, and then multiple logistic regression analysis was performed to identify possible risk factors of insomnia. Results In the 166 young female patients, the mean age was (30.90±5.96) years, and the mean perioperative ISI score was 8.83±4.97. Slight insomnia was found in 39.7% (66/166) of the patients, moderate insomnia was found in 12.7% (21/166), and severe insomnia was found in 2.4% (4/166). The results of multiple logistic regression suggested that the number of breast masses [taking the number=1 as the reference, when the number=4, odds ratio (OR)=2.269, 95% confidence interval (CI) (1.917, 13.818), P=0.001; when the number>4,OR=9.359, 95%CI (4.507, 19.433), P<0.001] and the maximum diameter of breast masses [taking 1–10 mm as the reference, when the maximum diameter was 26–30 mm,OR=6.989, 95%CI (1.488, 32.785), P=0.014; when the maximum diameter >30 mm, OR=17.290, 95%CI (4.664, 64.071), P<0.001] were independent risk factors of the severity of perioperative insomnia in these young women. Conclusion It is recommended that psychological nursing and comprehensive admission education should be enhanced for young patients who have >3 breast masses or the diameter of the mass is >25 mm, aiming to improve the postoperative recovery of patients with high risk of insomnia.
ObjectiveTo explore the utility and advantage of same-day surgery mode of Mammotome minimally invasive operation (MMT) in ambulatory surgery center, and summarize the key points of clinical management.MethodsFemale patients who underwent MMT in West China Hospital of Sichuan University between June and December 2019 were included. According to the operation mode, the patients were divided into same-day surgery group and routine group (routine day operation). The perioperative data were analyzed.ResultsA total of 1 297 female patients were included. Among them, 571 cases were in the same-day surgery group and 726 cases were in the routine group. There was no significant difference in baseline data, intra-operative bleeding volume, operation time, or complication rate between the two groups (P>0.05). There were significant differences in the number of masses (χ2=13.384, P<0.001), pathological type (χ2=11.990, P=0.007) and operation method (χ2=89.185, P<0.001). The length of hospital stay in the same-day surgery group was significantly shorter than that in the routine group (Z=–29.746, P<0.001); the cost of biopsy (Z=–8.549, P<0.001), the cost of surgical instruments (Z=–9.564, P<0.001), and the total cost of hospitalization (Z=–10.378, P<0.001) in the same-day surgery group were less than those in the routine group. In addition, the result of generalized estimating equation showed that the postoperative pain scores of patients in the same-day surgery group were lower than those in the routine group (P<0.001).ConclusionsThe same-day surgery mode of MMT is safe and feasible with high time economic benefits, which is worthy promoting in ambulatory surgery center. Cautions should addressed with patients’ safe and high-quality health education.