CAJ | 학술논문

目的探讨乳管内视镜直视下金属线定位用于引导乳头溢液患者导管解剖手术的价值.方法 174例经乳管内视镜确诊为乳管内占位性病变的乳头溢液患者接受了乳导管解剖术,其中68例术前在乳管内视镜直视下,将带倒勾的金属丝送至病灶处固定,并标记体表投影,以定位金属丝为引导实施乳导管解剖术,术中冰冻病理取材循定位导丝寻找病灶;另外106例采用传统的术中置平头针法或经溢液乳孔注射美兰法,作为对照.结果乳管内视镜定位组68例患者中,导管内乳头状瘤64例,导管原位癌4例,恶性率为5.9%,一次性病灶切除率、病理诊断与乳管内视镜诊断符合率均为100.0%,术后无一例发生局部变形.对照组106例患者中,导管内乳头状瘤96例,导管原位癌6例,恶性率为5.7%,乳腺腺病4例,一次性病灶切除率为77.4%,病理诊断与乳管内视镜诊断符合率为96.2%,术后26例发生局部变形.结论乳管内视镜直视下金属线定位引导乳导管解剖术具有定位精确、创伤小、冰冻病理取材准确、无局部乳腺组织变形等优点,既能提高乳腺导管疾病的诊断率,又能减少乳腺组织损伤,值得进一步研究与推广.
목적 탐토유관내시경직시하금속선정위용우인도유두일액환자도관해부수술적개치.방법 174례경유관내시경학진위유관내점위성병변적유두일액환자접수료유도관해부술,기중68례술전재유관내시경직시하,장대도구적금속사송지병조처고정,병표기체표투영,이정위금속사위인도실시유도관해부술,술중빙동병리취재순정위도사심조병조;령외106례채용전통적술중치평두침법혹경일액유공주사미란법,작위대조.결과 유관내시경정위조68례환자중,도관내유두상류64례,도관원위암4례,악성솔위5.9%,일차성병조절제솔、병리진단여유관내시경진단부합솔균위100.0%,술후무일례발생국부변형.대조조106례환자중,도관내유두상류96례,도관원위암6례,악성솔위5.7%,유선선병4례,일차성병조절제솔위77.4%,병리진단여유관내시경진단부합솔위96.2%,술후26례발생국부변형.결론 유관내시경직시하금속선정위인도유도관해부술구유정위정학、창상소、빙동병리취재준학、무국부유선조직변형등우점,기능제고유선도관질병적진단솔,우능감소유선조직손상,치득진일보연구여추엄.
Objective To evaluate and compare localization by ductoscopy-guided wire with localization by conventional methods in the terminal duct excision for women with pathological nipple discharge.Methods Breast terminal duct excision were performed in 174 consecutive patients with intraductal lesions diagnosed by mammary ductoscopy.Sixty-eight of those underwent ductoscopy-guided wire localization for more accurate duetal excision.The patients received mammary ductoscopy and a hooked wire was anchored at the intraductal lesions under endoscopic surveillance just before the operation.Then a biopsy resection of wire-guided terminal duct and frozen section were done.The other 106 patients received terminal duct excision under localization with conventional methods without ductoscopy either by puncturing a needle or injection of blue dye through the duct with pathological discharge.Results Of the 68 patients with ductoscopy-guided duct excision,64 had intraductal papillomas and 4 duct carcinoma in situ proved by pathology.All the lesions in these 68 patients were completely resected during biopsy without extra extended resection,and the concordance rate of the pathological result with ductoscopic diagnosis was 100.0%.None of them developed a postoperative breast distortion.In the conventional method localization group,there were 96 intraductal papilloma,6 duct carcinoma in situ and 4 adenosis.Only 77.4% of the lesions were excised in the primary biopsy,and 22.6% needed extended resection.The concordance rate of the pathological diagnosis with ductoscopic diagnosis was 96.2%.Twenty-six patients had a deformed breast postoperatively.Conclusion Ductoscopy-guided wire localization is superior to the conventional localization method in the surgical terminal duct excision for women with spontaneous nipple discharge.It is not only helpful for more accurate localization and resection as well as pathologic sampling,but also is minimally invasive.Further studies are still required and this method may deserve to be popularized.