| Background and Objective:With the promotion of the whole society and women's awareness of breast health, more and more lesions were detected in the early time; at the same time the significance of the breast as a symbol of beauty also began to gradually become the primary concern beyond the breast-feeding, and it played an indispensable role in their mental health regulation. Narrowing incision continually, keeping the breast appearance, while achieving a complete cure for the disease had become one of the key of medical research. Minimally invasive theory, minimally invasive techniques, minimally invasive devices'emerging has fueled the treatment principle now. Mammotome minimally invasive biopsy is a progress by leaps and bounds in minimally invasive breast surgery, expanded the coverage of minimally invasive surgery once again, and has laid a solid foundation for breast minimally invasive surgical treatment and diversification.Mammotome vacuum-assisted minimal invasive breast biopsy system was developed by the United States Johnson & Johnson. Application of Mammotome minimally invasive biopsy surgical treatment of benign breast lesions, the incision was hidden,scar was small, and had little effect on the breast appearance. It greatly reduced the patient's psychological trauma, are it was more vulnerable to female patients than it does with traditional surgery. Patients achieved satisfactory results. This paper is intended to summary application experience of the treatment of benign breast lumps by standardizing the procedure of Mammotome.Method:Choose the medical records from December 2003 to September 2009 who were underwent the treatment of benign breast lumps by the application of ultrasound-guided Mammotome minimally invasive biopsy in China-Japan Union Hospital of Jilin University. There were 1492 patients. Female patients'number was1428, the total lesions were 9438; they are 11 to 58 years old, and the median age is 34; multiple foci 1118, the most lesions in one was 39; unilateral cases were 206, bilateral cases is 1222; negative touching diagnosis were 2136 lesions; all the patients were examined by ultrasound examination preoperatively, the lesions'size are mostly 0.5 ~ 2.0 cm, and the others were large fibroadenoma (diameter greater than 3.0cm), and abscess lesions. In addition, there were 64 male patients, 14 to 25 years old , all of them were gynecomastia, unilateral cases of 20, 44 bilateral cases.Conventional surgical procedures:1. Patients'position and mark2. Mammotome connections and settings3. Local drug injection: Injection of the areola area: tumor excision with conventional injection method, taking the edge of the areola to be injected into the fan blade department. Side of the chest wall injection: Take the needle into hidden side of the chest wall, injected fan-shaped areas where the Mammotome cut into.4. Choosing incision: Areola incision;Lateral chest wall incision:.5. Ultrasonic Positioning: Preoperative ultrasound localization; intraopera- tive ultrasound localization.6. Mammotome minimally invasive surgery: The choice of anesthesia;surgical procedures; Pathology testing of the removed tissue.7. Surgery completion of hemostasis and put drainage: After the surgery, it required the pressure bandage in the early stage, which can effectively prevent postoperative bleeding and hematoma formation; if intraoperative bilateral breast surgery, it must give local hemostasis after one the side by the assistant to; if the excision is larger, drainage tube may be placed on knife-edge, it can be effectively observed drainage volume;8. Chest compression bandage: Bilateral breast compression should make the lateral margin oppressed to the inside, which is conducive to maintain breast shape; and oppressed the center, which can effectively prevent the formation of local depressions; filling bandage can avoid the trace on the edge.9. Postoperative management principles: Giving systemic anti-infective treatment after the surgery conventionally, if it was a lesser extent, give oral administration only; the temperature beyond 38.5℃was prompted local hematoma, which need be dressed to observe; drainage tube may be removed after 24 ~ 48 hours.Results:1. Patients selected criteria:(1) Select multiple lesions: multiple breast fibroadenoma, multiple points of breast limited cystic hyperplasia, multiple breast cysts, bilateral papillomatosis, and multiple points of galactocele;(2) Select the anatomical structures, complex lesions: areolar intraductal papilloma, mammary duct ectasia, axillary accessory breast, gynecomastia;(3) Select breast infectious lesions: acute breast abscess in breast-feeding, breast abscess in breast-feeding by the complications of breast enlargement by injected Amazingel;(4) Select the limited and suspected malignant change lesions: gynecomastia, limited breast mass cystic hyperplasia, minimally calcified nodule in breast.2. Patients' pathological results of statistics: the total number of selected cases is 6324, with a proportion of the total is 66.9% (a total of 960 people).multiple lesions were 5617, accounting for 59.4% (757 people); anatomical specificity lesions were 305, accounting for 3.2% (178 people); breast infectious lesions were 66, accounting for 0.7% (56 people); limited and suspected malignant change lesions were 424, accounting for 4.5% (227 people).3. Surgical site selected:According to preoperative B ultrasonic, forecast the type and nature of the lesions, then determine the scope of general surgery. (1) Limited lesions: excised of the lesion only, and decide on the next operation range until the pathology results return.(2) Multiple lesions: remove the lesions, at the same time modify the organizations among the lesions to ensure the appearance of the gland be smooth.(3) Anatomical structures and complex lesions: remove lesions completely as far as possible in the premise of doing not damage surrounding tissue.(4) Infectious lesions: eliminate of the infection of contents, remove the inner wall foci, and wash the cavity if it's necessary.4. Incision selection criteria:(1) Areolar incision: suitable for multiple, distribution wider, and the tumor located inside of the gland. A. Distribution of whole breast; B. Inside of breast.(2) Side of the chest wall incision: suitable for fewer tumors; the tumor was at the lateral margin of the gland; the patients have requirements on appearance; the young patients who were not feeding. A. Lateral breast; B. Areola type; C. Unmarried women or the patients have breast-feeding requirements; D. Accessory breast.5. The choice of anesthesia: (1) Local anesthesia; (2) General anesthesia.6. Pathology detection method: (1) Intraoperative frozen section method; (2) Postoperative routine paraffin embedding method.7. Assessment of breast scar (1) Wound area of skin: take a single mini-incision for multiple lesions; incision length reduced 10 times; (2) Minimally invasive surgery areas: single-tunnel (maximum diameter is 3mm) or multi-tunnel (limited length is 15cm);(3) Breast scar: no suturing is no scar left; no foreign body is no scar formation and no change on shape.8. The results of postoperative complications: Bleeding: 15 cases, 12 cases of them the operations were discontinued, and gave local compression, and then the bleeding had stopped, and continued to complete the operation. The other 3 cases of surgery had significant bleeding which occurred at the end. The bleeding was stopped after local pressure, and then we used elastic bandage dress. Local hematoma: 30 cases had petechiae in mild local skin, but gave no special treatment. After 2 weeks the petechiae skin was as normal. Local breast deformity: some patients had trauma from pin tract, and the breast surface had streak changed in short times. All patients had no complication of pectoralis and thoracic injuries, skin broken, bleeding after operations, infection and removal of non-net.Conclusion:1. The surgical treatment of benign breast lumps can be completed successfully by Mammotome minimally invasive biopsy system with the ultrasound guiding.2. The treatment of benign breast lumps by Mammotome minimally invasive biopsy was operated simply, resected completely, and the trauma was smaller, postoperative complications were fewer.3. With the surgical experience, surgical techniques and equipment improve- ments, the scope of surgical resection was expanded.4. According to the different natures and locations of the lesions, Mammotome minimally invasive surgical incision and anesthesia were chosen in different ways.The Mammotome minimally invasive biopsy is a treatment method for benign breast lesions, which is safe, reasonable, effective and in accordance with the aesthetic point of view. The surgery is simple, fast, beautiful, little trauma and quickly healing. The technology were advanced, creative, high-tech integrated in minimally invasive surgery in breast surgery at home and abroad, and it expressed a perfect effects of minimally invasive breast surgery . |
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