【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.
目的 探討Mammotome切除乳腺纖維腺瘤的價值。方法 對我院2006年12月至2008年3月期間超聲診斷為乳腺纖維腺瘤的107例患者共129枚病灶行超聲引導下Mammotome旋切術。結果 129枚腫瘤超聲顯示完整切除，腫物切除時間5~40 min，平均16 min。1例發生血腫，3例皮下瘀血，2例乳頭溢血，無一例感染。2例皮膚切割者以創可貼拉合后2 d愈合。病理結果顯示124枚為良性病變，5枚為惡性。年齡≥40歲者共20例，其中惡性3例。超聲顯示有鈣化灶者共6枚，其中3枚為惡性。103例獲門診隨訪，隨訪時間2～12個月，平均 5個月，超聲發現2例復發。結論 Mammotome切除乳腺纖維腺瘤可同時達到診斷及治療目的，美容效果好，對≥40歲及伴有鈣化者要警惕惡性病變。
【摘要】目的探討超聲導向下Mammotome活檢及旋切系統切除乳腺腫塊的并發癥及其處理。方法在超聲導向下，利用Mammotome系統對乳腺腫塊進行活檢和切除，對出現的并發癥進行及時的處理。結果46例患者的75個乳腺腫塊被切除，病理證實68個為纖維腺瘤，7個為纖維腺病。術中并發癥包括出血、血腫和胸大肌損傷，經及時處理后恢復，術后并發癥為瘢痕形成。結論Mammotome乳腺腫塊切除術具有創傷小、并發癥少的優點，是一種有效的、不影響乳房外觀的微創手術，超聲監控能夠減少和發現并發癥并進行正確的處理。
探討超聲引導下Mammotome微創旋切系統對乳腺病灶進行微創切除的治療價值。方法:在超聲圖像監控下,利用Mammotome 系統對680例1900個乳腺腫塊進行切除及病理檢查,并記錄術后隨訪情況。對其進行回顧性分析,評價其在乳腺微創外科的應用價值。結果:680例1900個乳腺腫塊被準確地完全切除,切除組織量大,足夠用于病理診斷,術后病理學診斷1例為惡性,其余均為良性。1175個腫塊為纖維腺瘤,661個腫塊為纖維腺病,19個腫塊為導管內乳頭狀瘤,42個腫塊為囊腫及囊性增生,2個腫塊為管狀腺瘤,1個腫塊為乳腺小管癌。術后每3~6個月定期接受復查,術后切口小而隱蔽,瘢痕不明顯, 乳腺外形及皮膚感覺正常,超聲未發現病灶殘留,復發。結論:Mammotome技術對乳腺病灶可進行完整切除,是準確、有效、安全、美觀、值得推廣的乳腺微創技術。
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.
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 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.