Effects of ultrasound-guided minimally invasive arthrotomy on pain and breast appearance in patients with breast fibroma
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摘要:
目的 观察超声引导微创旋切术对乳腺纤维瘤患者疼痛及乳房外观的影响。 方法 回顾性选取2020年11月~2021年4月于我院接受治疗的127例单发良性乳腺纤维瘤患者为研究对象，依据手术方式将其分为开放切除术组(n=44)和微创旋切术组(n=83)。开放切除术组行常规开放式切除手术治疗，微创旋切术组在超声引导下行微创旋切术治疗。观察比较两组患者围术期相关指标、术后乳房美容效果、患者满意度、术后并发症发生情况及手术前后视觉模拟量表评分。 结果 双侧乳腺超声下均表现为乳房皮肤回声清晰，腺体回声呈散在光点，分布欠均匀，内可见不规则稀疏区。微创旋切组手术时间、术中出血量、切口长度、瘢痕长度、切口愈合时间和住院时间均明显小于开放切除术组(P < 0.05)；术后6、12、24 h，微创旋切组患者视觉模拟量表评分均显著低于开放切除术组(P < 0.05)，乳房美容效果优良率和对乳房形状、大小、柔软度、对称性满意度评分均明显高于开放切除术组(P < 0.05)；微创旋切术组患者术后并发症发生率明显低于开放切除术组(P < 0.05)。 结论 超声引导微创旋切术治疗乳腺纤维瘤患者具有创伤小、恢复快、术后并发症少等显著优点，可显著缓解患者术后疼痛，且术后美观性好，患者满意度高。 Abstract:Objective To observe the effect of ultrasound-guided minimally invasive surgery on pain and breast appearance in patients with breast fibroma. Methods A total of 127 patients with single benign breast fibroma who received treatment in our hospital from November 2020 to April 2021 were retrospectively selected. They were divided into open resection group (n=44) and minimally invasive resection group (n=83) according to surgical methods. In the open resection group, conventional open resection was performed, while in the minimally invasive resection group, ultrasound-guided minimally invasive resection was performed. Perioperative related indicators, postoperative breast cosmetic effect, patient satisfaction, postoperative complications and visual analog scale (VAS) score before and after surgery were observed and compared between the two groups. Results Under ultrasonography of both mammary glands, the breast skin echo was clear, and the gland echo was scattered in light spots, with uneven distribution and irregular sparse areas. The operative time, intraoperative blood loss, incision length, scar length, incision healing time and hospital stay in minimally invasive rotation group were significantly shorter than those in open resection group (P < 0.05). VAS scores in minimally invasive rotation group were significantly lower than those in open resection group at 6, 12 and 24 h after surgery (P < 0.05). The rate of excellent breast cosmetic effect and satisfaction score on breast shape, size, softness and symmetry were significantly higher than those in open resection group (P < 0.05). The incidence of postoperative complications in minimally invasive rotatectomy group was significantly lower than that in open resection group (P < 0.05). Conclusion Ultrason-guided minimally invasive rotatectomy for breast fibroma patients has significant advantages such as less trauma, quick recovery and less postoperative complications. It can significantly relieve postoperative pain of patients, and has good postoperative aesthetics and high patient satisfaction. -
图 1 乳腺纤维瘤超声图
A: 形态欠规则, 边界可认, 内回声欠均匀, CDFI示其内未见明显血流信号; B: 右乳皮肤回声清晰, 腺体回声呈散在光点, 分布欠均匀, 内可见不规则稀疏区; C: 右乳可见数枚囊性回声, 大者约0.4 cm×0.3 cm, 壁薄, 内液清; D: 左乳11点钟位置腺体层内可见一枚稍弱回声, 形态不规则, 边缘呈毛刺征, 边界不清其内可见血流信号.
Figure 1. Ultrasonography of breast fibroma
表 1 两组患者围术期相关指标比较
Table 1. Comparison of perioperative related indicators between the two groups (Mean±SD)
组别 手术时间(min) 术中出血量(mL) 切口长度(mm) 瘢痕长度(mm) 切口愈合时间(d) 住院时间(d) 微创旋切术组(n=83) 18.61±3.07 10.17±3.66 4.50±0.48 2.09±0.49 3.59±0.87 4.03士0.89 开放切除术组(n=44) 33.07±2.86 57.12±9.73 27.14±5.94 19.40±2.08 7.83士2.16 8.75士1.76 t 25.852 39.150 34.633 72.356 15.684 20.103 P < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 
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表 2 两组患者手术前后VAS评分比较
Table 2. Comparison of VAS scores between the two groups before and after surgery (points, Mean±SD)
组别 术前 术后6h 术后12h 术后24h 微创旋切术组(n=83) 1.33士0.27 5.76士1.54 4.21士1.38 3.61士0.89 开放切除术组(n=44) 1.28士0.30 7.01士1.67 6.14士1.73 4.97士1.26 t 0.955 4.278 6.856 7.064 P 0.341 < 0.001 < 0.001 < 0.001
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表 3 两组患者乳房美容效果比较
Table 3. Comparison of breast cosmetic effect between the two groups [n(%)]
组别 优 良 差 优良率 微创旋切术组(n=83) 57(68.67) 21(25.30) 5(6.02) 78(93.98) 开放切除术组(n=44) 13(29.55) 22(50.00) 9(20.45) 35(79.55) t 6.105 P 0.013
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表 4 两组患者满意度比较
Table 4. Comparison of patient satisfaction between the two groups (points, Mean±SD)
组别 乳房形状 乳房大小 乳房柔软度 乳房对称性 微创旋切术组(n=83) 2.53±0.26 2.61±0.19 2.55±0.22 2.59±0.31 开放切除术组(n=44) 1.94±0.57 1.90±0.63 1.89±0.46 1.23±0.50 t 8.006 9.512 10.946 18.891 P < 0.001 < 0.001 < 0.001 < 0.001
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表 5 两组患者术后并发症发生率比较
Table 5. Comparison of incidence of postoperative complications between the two groups [n (%)]
组别 切口感染 血肿 局部瘀斑 乳房变形 总发生率 微创旋切术组(n=83) 1(1.20) 0(0.00) 1(1.20) 1(1.20) 3(3.57) 开放切除术组(n=44) 2(4.55) 1(2.27) 4(9.09) 2(4.55) 9(20.45) t 9.531 P 0.002
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