CAJ | 학술논문

目的探讨基层医院开展超声引导下乳腺肿块真空辅助活检的应用和患者的认知程度.方法回顾性分析广东省惠州市惠东县妇幼保健院乳腺中心2012年9月-2014年9月活检乳房肿块1691例的病例资料,其中超声引导真空辅助活检1004例,1325个肿块,开放手术687例,712个肿块,全部经病理切片检查.结果真空辅助活检1325个肿块,发现乳腺癌7例,占0.7％;术后皮下瘀斑21例,占2.1％;血肿10例,占1％.手术耗时2 ～ 26 min.单侧病灶平均住院费用为6490元.开放手术712个肿块中,发现乳腺癌9例,占3.8％,术后皮下淤血8例,占1.2％,无血肿发生,手术耗时35 ～74 min,单侧平均住院费用为3805元.随访3～27个月,真空辅助活检术后原位乳腺纤维瘤复发5例,占0.5％,开放手术复发3例,占0.4％,差异无统计学意义(P＞0.05).满意度调查发现,真空辅助活检术伤口美观占97.4％(P＜0.05).两组病例术后疼痛均轻微(P＞0.05).真空辅助活检术费用高于开放手术2485元.两组病例中993例4a级发现乳腺癌2例(0.2％),132例4b级发现乳腺癌10例(7.6％)和2例5级中发现乳腺癌2例(100％),2～3级中未发现乳腺癌.结论真空辅助活检术在基层医院中不但可以快速准确地诊断早期乳腺癌,也可以对良性肿块进行活检手术,技术容易掌握,操作安全快速,伤口美观,患者满意度高.严格选择病例可以减少血肿并发症.超声BIRADS分级对于乳房肿块诊治有较好的指导意义,减少乳腺癌漏诊,配合微创活检技术是适宜基层推广的乳腺疾病诊治技术.
목적 탐토기층의원개전초성인도하유선종괴진공보조활검적응용화환자적인지정도.방법 회고성분석광동성혜주시혜동현부유보건원유선중심2012년9월-2014년9월활검유방종괴1691례적병례자료,기중초성인도진공보조활검1004례,1325개종괴,개방수술687례,712개종괴,전부경병리절편검사.결과 진공보조활검1325개종괴,발현유선암7례,점0.7％;술후피하어반21례,점2.1％;혈종10례,점1％.수술모시2 ～ 26 min.단측병조평균주원비용위6490원.개방수술712개종괴중,발현유선암9례,점3.8％,술후피하어혈8례,점1.2％,무혈종발생,수술모시35 ～74 min,단측평균주원비용위3805원.수방3～27개월,진공보조활검술후원위유선섬유류복발5례,점0.5％,개방수술복발3례,점0.4％,차이무통계학의의(P＞0.05).만의도조사발현,진공보조활검술상구미관점97.4％(P＜0.05).량조병례술후동통균경미(P＞0.05).진공보조활검술비용고우개방수술2485원.량조병례중993례4a급발현유선암2례(0.2％),132례4b급발현유선암10례(7.6％)화2례5급중발현유선암2례(100％),2～3급중미발현유선암.결론 진공보조활검술재기층의원중불단가이쾌속준학지진단조기유선암,야가이대량성종괴진행활검수술,기술용역장악,조작안전쾌속,상구미관,환자만의도고.엄격선택병례가이감소혈종병발증.초성BIRADS분급대우유방종괴진치유교호적지도의의,감소유선암루진,배합미창활검기술시괄의기층추엄적유선질병진치기술.
Objective To investigate the application of ultrasound-guided vacuum-assisted biopsy for breast masses in primary hospital and the degree of patients' cognition.Methods A retrospective analysis of 1691 female patients in the department of breast diseaseofHuidongwomen and children hospital from September 2012 to September 2014 undergoing biopsy, 1004 casesofultrasound-guided vacuum-assisted biopsy with 1325 masses, and 687 Cases of open surgery with 712 masses, all confirmed by pathological examination after operation.Results In 1325 masses in 7 breast cancercases accounted for 0.7％.Twenty-one (2.1％)cases of postoperative subcutaneous ecchymosis, hematoma in 10(1％) cases.Operation takes 2-26 min.Average hospitalization expenses of unilateral lesions was 6490 yuan.712 masesby open surgery in 9 infiltrating ductal carcinoma accounts for 3.8％ , 8(1.2％) postoperative cases of subcutaneous ecchymosis, 0 case withhematoma, operationtakes 35 to 74 minutes.Average hospitalization expenses of unilateral lesions was 3805 yuan.The follow-up of 3 to 27 months.Recurrenceof 5 fibroadenoma by vacuum-assisted biopsy and 3 by open surgery, there was no difference between its (P ＞ 0.05).Survey was found 97.4％ good cosmetic effectby vacuum-assisted biopsy, significantly higher than open surgery (P ＜ 0.05).There were mild pain after two kinds of operations, no difference (P ＞ 0.05).The cost of vacuum-assisted biopsy was higher than 2485 vuan of open operation.Grade 4a in 993cases with ultrasonic diagnosis found 2 cases of breast cancer (0.2％) in two groups of patients, and grade 4b in 132 cases found 10 cases of breast cancer (7.6％) and 2 cases in grade 5 was breast cancer (100％), and nobreast cancer in 2-3 grade was found.Conclusions Ultrasound-guided vacuum-assisted biopsy is not only fast and accurate diagnosis of early breast cancer, but also be further one-step surgical biopsy of benign tumor in primary hospital, and is safe, simple and convenient operation with high postoperative satisfaction.Strictly select a case can reduce hematoma complications.The ultrasonic BIRADS grade has good guidance for breast masses of diagnosis and treatment, and can reduce the missed diagnosis of breast cancer.Ultrasound-guided vacuum-assisted biopsyand BIRADS grade of breast massesare appropriate technology for diagnosis and treatment in the primary hospitals.