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目的分析乳腺立体定位下钢丝置入移位的表现、原因、处理方法,提高术前定位的准确性。方法行立体定位置入钢丝患者79例,96个病变,发生钢丝移位13例。结果立体定位中发生钢丝移位5例,原因分别来自于患者和操作医师;立体定位完成后钢丝移位5例,原因是局麻注射药物过多,导致乳腺 Z 轴的深度与计算机提示的实际深度不符合、放置定位针的方法不正确、拔出钢丝外套针套时疏忽钢丝是否已锚定病变。处理方法:可按照钢丝提示位置向病变方向移位2 cm 以内进行手术,重新放置第2根钢丝,将双 J 型钢丝收入针套并取出体外,重新定位。手术中钢丝脱出2例,因术后过分提拉钢丝所致,放射科医师放置钢丝后应向外科医师准确描述深度、方向,并从距离钢丝头端距离皮肤最近处取切口手术。术后标本未见钙化1例,与钙化位于手术电刀破坏的腺体内有关,可扩大范围切除并短期复查,证实钙化是否完整切除。结论正确认识乳腺 X 线立体定位下钢丝移位的表现,熟练掌握其处理方法,可提高对不可触及的乳腺病变的定位准确性,正确引导外科手术。
Objective To analyze the manifestations, causes and treatment of the wire placement and displacement under stereotactic mammography and to improve the accuracy of preoperative localization. Methods Stereotactic placement of steel wire in 79 cases, 96 lesions, occurred in 13 cases of wire displacement. Results Stereotacticity occurred in 5 cases of wire displacement, the reasons were from the patient and the operating physician; Stereotaxic wire positioning after the completion of the shift in 5 cases because of local anesthetic injection of drugs, leading to the depth of the breast Z axis and the computer prompted the actual The depth of non-compliance, the method of placing the positioning pin is not correct, pull out the wire jacket sleeve negligence wire has anchored the lesion. Approach: According to the tips of the wire to the lesion within 2 cm displacement within the operation, reposition the second wire, the double J-type wire into the needle sleeve and removed from the body, re-positioning. Surgery in 2 cases of steel prolapse, due to excessive pull wire after surgery, the radiologist should be accurately placed to the surgeon to describe the depth, direction, and distance from the tip of the wire from the skin near the incision surgery. No cases of calcification in 1 case, and calcification in the destruction of the surgical gland on the electric knife, can expand the scope of resection and short-term review to confirm the complete removal of calcification. Conclusion Correct understanding of mammography under the wire position shift performance, proficiency in its treatment methods, can improve the positioning accuracy of non-palpable breast lesions, and correctly guide the surgical operation.