Mammotome微创旋切系统在男性乳房发育症治疗中的应用价值的研究
摘要
目的探讨超声引导下Mammotome乳腺微创旋切系统在男性乳房发育症治疗中的应用价值。方法我院2002年2月至2006年4月,经临床诊断为男性乳房发育症患者90例,均排除继发性男性乳房发育症。超声引导下Mammotome行增生腺体旋切手术30例,行常规手术切除治疗60例。术中记录,术后密切随访,比较并评价它们的治疗效果。结果超声清晰地显示了Mammotome治疗GYN全过程,显示率100% , 30例行Mammotome手术患者中增生腺体直径≤1.5cm的患者12例,完全切除者12例(100%);直径>1.5cm的患者18例,其中直径1.5～3.0cm的患者12例,完全切除者12例(100%),直径>3.0cm的患者6例,完全切除者5例(83.3%)。30例患者平均切口疤痕0.3cm,术后仅1例有渗血。其余60例行常规手术切除,常规手术组患者增生腺体直径≤3.0cm的患者40例,完全切除者38例(95%.),其中腺体直径﹥3.0cm的患者20例,完全切除者18例(90%),常规手术切除术后发生并发症13例,其中渗血3例,乳头、乳晕皮肤色泽不良3例,切口感染1例,切口内积血或积液5例,以上病例均经再手术止血或换药后痊愈,此60例患者全部存在切口疤痕(2.0～5.0cm),平均2.5cm。其中1例由于瘢痕体质,出现严重手术瘢痕。结论超声引导下的Mammotome微创旋切系统在治疗男性乳房发育症具有穿刺准确、操作简单,切除彻底,
创伤小,术后并发症少,明显优于常规手术切除方式。可以完整切除小于3.0cm的增生腺体。对于无手术禁忌症,经济条件允许,有美容要求的患者可实施Mammotome乳腺微创旋切系统。
Objective The operations and biopsy for gynecomastia 30were performed by ultrasound guided Mammotome minimallyinvasive biopsy system in China-Japan Union Hospital betweenFebruary 2002 and April 2006.We gain a satisfactory effect,andmeantime it contrasted to the conventional operation.The purposeof this article is to evaluate result for diagnosis and treatment ofgynecomastia by Mammotome minimally invasive biopsy system.
Methods Ninety patients were diagnosed gynecomastia byclinical physical examination,and these patients were not secondarygynecomastia .In the 90 patients ,60 patients were operated byconventional exairesis and 30 patients were operated by ultrasoundguided Mammotome minimally invasive biopsy system. Ifdiameter of hyperplasty Mammary gland ﹥1.5cm,we use needlewhich tipe is 8G,on the contrary , If diameter of hyperplastyMammary gland ≦ 1.5cm,we use needle which tipe is 11G.
Result All the 29 lesions were completely removed byultrasound guided Mammotome minimally invasive biopsysystem ,but 13 lesion were not completely removed because itsdiameter is too long and experiments not very skillful. A mean of35 times(13-47) of excision per lesion and The operative timewas14-40min (mean,23min) with 11G needle for diameter≦ 1.5cm.A mean of 102 times(13-167) of excision per lesion and The
operative time was15-160min (mean,60min) with 8G needle fordiameter﹥1.5cm.But by conventional surgery, the operative timewas7-28min (mean,20min) with conventional scalpel fordiameter ≦ 1.5cm. By the mean method the operative timewas30-165min (mean,50min) for diameter﹥1.5cm.The length ofincision was only 3-4mm.Slight subcutaneous ecchymosis andlocal hematom a were noted in 1 patients and 1 lesion were notcompletely removed because its diameter is too long andexperiments not very skillful.These patients after operation,respectively Clinical and B-ultrasonic examinations revealed nomalfindings in the 10 patients on the follow-up every 3-6months. 60patients by conventional surgery emerge cicatricle,serverecicatricle 1, capillary hemorrhage 3,hypo haematocele andfluidify 5, infection 1 , the colour of mammary papilla poor3,region palindromia 2 .Conclusion Gynecomastia can be cured successfully byultrasound guided Mammotome minimally invasive biopsysystem.We can integritilly ectomise mammary gland by it ifd ≦1.5cm and mammotome have much forte,such as handingsimply,ectomise integrity, minimally invasive,less complications.Ultrasound guided Mammotome minimally invasive biopsy systemis obviously much better than traditional surgery.With regard tothese patients no surgical contraindication,asking for facial canenforce Mammotome minimally invasive biopsy system.
创伤小,术后并发症少,明显优于常规手术切除方式。可以完整切除小于3.0cm的增生腺体。对于无手术禁忌症,经济条件允许,有美容要求的患者可实施Mammotome乳腺微创旋切系统。
Objective The operations and biopsy for gynecomastia 30were performed by ultrasound guided Mammotome minimallyinvasive biopsy system in China-Japan Union Hospital betweenFebruary 2002 and April 2006.We gain a satisfactory effect,andmeantime it contrasted to the conventional operation.The purposeof this article is to evaluate result for diagnosis and treatment ofgynecomastia by Mammotome minimally invasive biopsy system.
Methods Ninety patients were diagnosed gynecomastia byclinical physical examination,and these patients were not secondarygynecomastia .In the 90 patients ,60 patients were operated byconventional exairesis and 30 patients were operated by ultrasoundguided Mammotome minimally invasive biopsy system. Ifdiameter of hyperplasty Mammary gland ﹥1.5cm,we use needlewhich tipe is 8G,on the contrary , If diameter of hyperplastyMammary gland ≦ 1.5cm,we use needle which tipe is 11G.
Result All the 29 lesions were completely removed byultrasound guided Mammotome minimally invasive biopsysystem ,but 13 lesion were not completely removed because itsdiameter is too long and experiments not very skillful. A mean of35 times(13-47) of excision per lesion and The operative timewas14-40min (mean,23min) with 11G needle for diameter≦ 1.5cm.A mean of 102 times(13-167) of excision per lesion and The
operative time was15-160min (mean,60min) with 8G needle fordiameter﹥1.5cm.But by conventional surgery, the operative timewas7-28min (mean,20min) with conventional scalpel fordiameter ≦ 1.5cm. By the mean method the operative timewas30-165min (mean,50min) for diameter﹥1.5cm.The length ofincision was only 3-4mm.Slight subcutaneous ecchymosis andlocal hematom a were noted in 1 patients and 1 lesion were notcompletely removed because its diameter is too long andexperiments not very skillful.These patients after operation,respectively Clinical and B-ultrasonic examinations revealed nomalfindings in the 10 patients on the follow-up every 3-6months. 60patients by conventional surgery emerge cicatricle,serverecicatricle 1, capillary hemorrhage 3,hypo haematocele andfluidify 5, infection 1 , the colour of mammary papilla poor3,region palindromia 2 .Conclusion Gynecomastia can be cured successfully byultrasound guided Mammotome minimally invasive biopsysystem.We can integritilly ectomise mammary gland by it ifd ≦1.5cm and mammotome have much forte,such as handingsimply,ectomise integrity, minimally invasive,less complications.Ultrasound guided Mammotome minimally invasive biopsy systemis obviously much better than traditional surgery.With regard tothese patients no surgical contraindication,asking for facial canenforce Mammotome minimally invasive biopsy system.
引文
[1] Lovin Jo, Parker leuthhe JM, et al. Sterotactic percutaneous breast core biopsy technical adaptation and initial experience [J]. Breast disease, 1999, 3(5):135-143.
[2] Parker SH, lovin JD. Jobe, et al. Sterotactic breast biopsy with a biopsy gun [J]. Radiology, 1998, 176(8): 741-747.
[3] Jackman RJ, Nowels KW, Shepard MJ, et al. Sterotactic large core neddle biopsy of 450 nonpalpable breast with surgical correlation in lesion with canner of atypical hyperplasic [J]. Radiology,1998,193(3): 91-95.
[4] Libermanl L,Cohen MA, Dershaw DD, et al. Atypical ductcal hyperplasia diagnosed at steretactic core biopsy [J]. Am roentgenol,1955,164(10):1111-1113.
[5] Iwuagwu OC, Calvey TA, Ilsley D, Drew PJ. Ultrasound guided minimally invasive breast surgery (UMIBS): a superior technique for gynecomastia.[J]. Ann Plast Surg. 2004 Feb;52(2):131-3.
[6] Burbank F,Parker SH,Fogarty TJ. Stereotactic breast biopsy improved tissue harvesting with the Mammotome [J]. AmSurgy, 1996,6(2):738-744.
[7] Klemd D, Jacobs HK, Jorgensen R, et al. Stereotactic breast biopsy in a community hospital setting[J]. Am sury, 1999, 65(7):737-740.
[8] Parker SH job WEDennis Ma, et al. us-guided automated large core breast biopsy[J]. Rediology,1993,187(6):507-511.
[9] Searen ED. Ultrasound guided biopsy of nonplapable breast masses by surgeous, Am surgey oncol, 1996:476-481
[10] 郇金亮,蔡清平,王强. 应用Mammotome微创旋切系统诊治乳腺病变. 中国普通外科杂志,2003,12:778-780
[11] 王强,张建金,蔡清萍,等.微创旋切手术治疗女性多发性乳房肿块.解放军医学杂志,2004,29:453-454。
[12] Huber S , Wagner M,Medl M, et al.Benign breast lesions:minimally invasive vacuum-assisted biopsy with 11-gauge needles patient acceptance and dffect on follow-up imaging findings. radiology 2003,226:783-790.
[13] 续哲莉,边学海. Mammotome微创旋切系统在乳腺外科中的 应 用 ( 附 132 例 分 析 ). 中 国 微 创 外 科 杂 志.2005,5(9) :754-756.
[14] Cangiarella J,Waisman J,Symmans WF,et al. Mammotone Core Biopsy for Mammary Microcalcifcation-Analysis of 160 biopsies from 142 women with surgical and radiologic follow.[J] .Cancer, 2001,91: 173-177.
[15] 陈方红,陈述政,曾春来,等.超声引导下微创旋切活检系统在乳腺疾病中的应用.中国超声诊断杂志,2004 , 5:530-531
[16] Baez E, Huber A,Vetter M, et al. Minimal invasive complete excision of benign breast tumors using a three-dimensional ultrasoundguided mammotome vacuum device.Ultrasound Obstet Gynecol,2003, 21: 267-272
[17] 郇金亮,王强,叶来英,等。超声引导下微创旋切术治疗男性乳房肥大症.中国微创外科杂志,2005. 5(9):754-756
[18] 郇金亮,王强,邢丽,等.钼靶X线检查及Mammotome微创旋切 在 乳 腺 疾 病 诊 治 中 的 应 用 . 中 国 实 用 外 科 杂志,2004,24:101-102
[19] Johnson AT,Henry-Tillman RS,Smith LF,et al. Percutaneous excisional bresat biopsy. Am J Surg,2002,184:550-554
[20] Sittek H,Kessler M,Untch M,et al. Minimally invasive biopsy and preoperative marking of suspect mammary lesions. Gynakol Geburtshilfliche Rundsch, 2004, 44:69-83
[21] 王红鹰,邹强,周坚,等.B超引导下的乳腺纤维腺瘤微创切术.中国微创外科杂志,2001,1:280-281.
[2] Parker SH, lovin JD. Jobe, et al. Sterotactic breast biopsy with a biopsy gun [J]. Radiology, 1998, 176(8): 741-747.
[3] Jackman RJ, Nowels KW, Shepard MJ, et al. Sterotactic large core neddle biopsy of 450 nonpalpable breast with surgical correlation in lesion with canner of atypical hyperplasic [J]. Radiology,1998,193(3): 91-95.
[4] Libermanl L,Cohen MA, Dershaw DD, et al. Atypical ductcal hyperplasia diagnosed at steretactic core biopsy [J]. Am roentgenol,1955,164(10):1111-1113.
[5] Iwuagwu OC, Calvey TA, Ilsley D, Drew PJ. Ultrasound guided minimally invasive breast surgery (UMIBS): a superior technique for gynecomastia.[J]. Ann Plast Surg. 2004 Feb;52(2):131-3.
[6] Burbank F,Parker SH,Fogarty TJ. Stereotactic breast biopsy improved tissue harvesting with the Mammotome [J]. AmSurgy, 1996,6(2):738-744.
[7] Klemd D, Jacobs HK, Jorgensen R, et al. Stereotactic breast biopsy in a community hospital setting[J]. Am sury, 1999, 65(7):737-740.
[8] Parker SH job WEDennis Ma, et al. us-guided automated large core breast biopsy[J]. Rediology,1993,187(6):507-511.
[9] Searen ED. Ultrasound guided biopsy of nonplapable breast masses by surgeous, Am surgey oncol, 1996:476-481
[10] 郇金亮,蔡清平,王强. 应用Mammotome微创旋切系统诊治乳腺病变. 中国普通外科杂志,2003,12:778-780
[11] 王强,张建金,蔡清萍,等.微创旋切手术治疗女性多发性乳房肿块.解放军医学杂志,2004,29:453-454。
[12] Huber S , Wagner M,Medl M, et al.Benign breast lesions:minimally invasive vacuum-assisted biopsy with 11-gauge needles patient acceptance and dffect on follow-up imaging findings. radiology 2003,226:783-790.
[13] 续哲莉,边学海. Mammotome微创旋切系统在乳腺外科中的 应 用 ( 附 132 例 分 析 ). 中 国 微 创 外 科 杂 志.2005,5(9) :754-756.
[14] Cangiarella J,Waisman J,Symmans WF,et al. Mammotone Core Biopsy for Mammary Microcalcifcation-Analysis of 160 biopsies from 142 women with surgical and radiologic follow.[J] .Cancer, 2001,91: 173-177.
[15] 陈方红,陈述政,曾春来,等.超声引导下微创旋切活检系统在乳腺疾病中的应用.中国超声诊断杂志,2004 , 5:530-531
[16] Baez E, Huber A,Vetter M, et al. Minimal invasive complete excision of benign breast tumors using a three-dimensional ultrasoundguided mammotome vacuum device.Ultrasound Obstet Gynecol,2003, 21: 267-272
[17] 郇金亮,王强,叶来英,等。超声引导下微创旋切术治疗男性乳房肥大症.中国微创外科杂志,2005. 5(9):754-756
[18] 郇金亮,王强,邢丽,等.钼靶X线检查及Mammotome微创旋切 在 乳 腺 疾 病 诊 治 中 的 应 用 . 中 国 实 用 外 科 杂志,2004,24:101-102
[19] Johnson AT,Henry-Tillman RS,Smith LF,et al. Percutaneous excisional bresat biopsy. Am J Surg,2002,184:550-554
[20] Sittek H,Kessler M,Untch M,et al. Minimally invasive biopsy and preoperative marking of suspect mammary lesions. Gynakol Geburtshilfliche Rundsch, 2004, 44:69-83
[21] 王红鹰,邹强,周坚,等.B超引导下的乳腺纤维腺瘤微创切术.中国微创外科杂志,2001,1:280-281.