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目的:分析乳腺立体定位钢丝置入失败的表现、原因、处理方法,提高术前定位的准确性.方法:乳腺立体定位置入钢丝149例(171个病变),成功顺利置入钢丝并引导外科手术108例,定位失败41例,其中看到病变而无法定位26例,钢丝移位15例:立体定位过程中钢丝移位5例(Y轴方向移位3例、X轴方向移位2例),立体定位完成后Z轴方向移位7例,手术中钢丝脱出2例,术后标本难以明确病变是否切除1例.结果:看到病变而无法定位26例:取消定位17例,采取积极措施有效排除障碍后成功定位9例.钢丝移位15例:立体定位中发生钢丝移位原因分别来自于患者和操作医生;立体定位完成后钢丝移位原因:局麻注射药物过多、放置定位针及退出针套的方法不正确,以上情况均被手风琴效应夸大.处理方法:移位小于2cm,对照钼靶片可按照钢丝提示位置向病变方向进行手术,移位超过2cm,需重新放置第2根钢丝定位.放射科医生放置钢丝后应向外科医生准确描述深度、方向,并从距离钢丝头端距离皮肤最近处取切口手术可避免手术中钢丝脱出,术后标本不明确病变是否完整切除时,需扩大范围切除并密切随访.结论:乳腺X线立体定位下置入钢丝引导外科手术是诊断不可触及乳腺病变(NPBL)的金标准方法.正确认识钢丝失败的表现,熟练掌握其处理方法,可提高对NPBL的定位准确性,正确引导外科手术.
OBJECTIVE: To analyze the manifestations, causes, treatment and the accuracy of preoperative localization of breast stereotactic wire placement.Methods: 149 cases (171 lesions) were implanted with stereotactic mammography, and successfully placed the wire and guided surgery There were 108 cases of surgery and 41 cases of unsuccessful positioning. Among them, 26 cases could not be located and the wires were displaced in 15 cases: 5 cases of wire displacement during stereotactic positioning (3 in Y-axis and 2 in X-axis) ), Three-dimensional positioning is completed after the shift of the Z-axis direction in 7 cases, 2 cases of surgical removal of steel wire, the specimen is difficult to clear the lesion after resection in 1 case.Results: 26 cases can not locate the lesion to see: cancel the positioning of 17 cases, take a positive Effective measures to eliminate obstacles after the successful positioning of 9. Steel wire displacement in 15 cases: the three-dimensional positioning of the wire shift occurred from the patient and the operating doctor; Stereotaxic wire positioning after the completion of the shift reasons: local anesthetic injection too much drug, positioning Needle and exit the needle sleeve is not correct, the above situation is exaggerated accordion effect.Methods: The displacement is less than 2cm, control molybdenum target piece can be in accordance with the direction of the wire tips to the lesion surgery, the displacement of more than 2cm, to be re-placed 2 roots Wire positioning. Radiologists placed the wire should be accurate to the surgeon to describe the depth and direction, and from the distance from the tip of the wire near the skin incision to take surgery to avoid surgical steel wire prolapse, the specimen is not clear whether the complete resection of the lesion, Need to expand the scope of excision and close follow-up.Conclusion: Breast X-ray stereotactic placement of wire guided surgery is the gold standard method for the diagnosis of non-palpable breast lesions (NPBL). Correct understanding of the failure of the wire performance, master their handling methods, Improve the accuracy of NPBL positioning, and correctly guide the surgery.