Clinical Controlled Analysis Of Single Port Endoscopic Breast Tumor Resection Through Axillary Fold And Routine Operation In The Treatment Of Benign Breast Tumors

Objective:This study compared and analyzed the clinical indicators of single port endoscopic breast tumor resection through axillary fold with routine operation,in order to introduce and analyze its application value,advantages and disadvantages in patients with benign breast tumors.Methods:A total of 75 patients with benign breast tumors who were admitted to the Department of Thyroid and Mammary surgery from September 2016 to December 2018 were enrolled.The patients were divided into endoscopic group and routine according to their surgical intention.Among them,34 cases in the single group(according to the number of tumors,there were 25 cases in the single group and 9 cases in the multiple group)were treated with single port endoscopic breast tumor resection through axillary fold;40 cases in the routine group(27cases in the single group and 13 cases in the multiple group)were treated by routine operation with a radial incision or a ring-shaped incision.The length of incision,operation time,intraoperative bleeding volume,distance from the incision to the distal end of the lesion,hospitalization time and cost,incidence of surgical,appearance satisfaction and scar scores were compared between the two groups.SPSS19.0 statistical software was used to analyze the data.T-test was used for the measurement data which conforming to the normal distribution;Mann-Whitney-U test was used for the data which did not conform to the normal distribution;meanwhile,in the endoscopic group(single group),the multiple correlation analysis was conducted on the operation time,diameter of lesion and the distance from incision to the distal end of the lesion.In the multiple group,the linear correlation analysis was made between operation time and the number of lesions.The difference was statistically significant if the P value less than 0.05.Results:All the 75 cases were successfully completed.No serious complications(nipple,areola/flap necrosis,infection,postoperative active bleeding,subcutaneous effusion or hematoma,subcutaneous emphysema,poor wound healing,etc.)were found in all groups.1.Operation time: compared with routine surgery,endoscopic surgery took longer time,the difference was statistically significant(P<0.05).Single group: endoscopic group(51.95±11.91)min vs.routine group(37.32±5.69)min;Multiple group:endoscopic group(69.83±7.12)min vs.routine group(49.85±8.69)min.2.Incision length: the incision length of endoscopic surgery was shorter than that of routine surgery,the difference was statistically significant(P<0.05).Single group:endoscopic group(3.00±0.52)cm vs.routine group(3.34±0.60)cm;Multiple group:endoscopy group(5.23±1.43)cm vs.routine group(7.09±2.28)cm.3.Intraoperative bleeding: the volume of bleeding in endoscopic surgery was less than that in routine surgery,and the difference was statistically significant(P<0.05).Single group: endoscopic group(4.37±0.63)ml vs.routine group(6.86±1.76)ml;Multiple group: endoscopic group(7.22±1.80)ml vs.routine group(11.33±1.99)ml.4.Hospitalization time: there was no significant difference in hospitalization time between endoscopic surgery and routine surgery(P>0.05).Single group: endoscopic group [median 4(3-7)] days vs.routine group [median 4(3-6)] days;multiple group:endoscopic group [median 4(4-7)] days vs.routine group [median 4(3-7)] days.5.Hospitalization cost: the hospitalization cost of endoscopic surgery was higher than routine surgery,and the difference was statistically significant(P<0.05).Single group: endoscopic group(9018.08±1435.34)yuan vs.routine group(4465.15±516.47)yuan;multiple group: endoscopic group(9754.25±863.93)yuan vs.routine group(6822.54±1516.75)yuan.6.Postoperative complications: the incidence of surgical complications was similar between endoscopic surgery and routine surgery,the difference was not statistically significant(P>0.05).7.Postoperative satisfaction: endoscopic surgery was more satisfactory than routine surgery,the difference was statistically significant(P<0.05).Total satisfaction of single group: endoscopic group 100% vs.routine group 78%;total satisfaction of multiple group: endoscopic group 100% vs.routine group 69.3%.8.Postoperative cosmetic score: the cosmetic score of endoscopic surgery was higher than routine surgery,and the difference was statistically significant(P<0.05).Single group: endoscopic group [median 14(13-15)] points vs.routine group [median12(9-15)] points;multiple group(14.00±0.87)vs.routine group(11.85±1.52)points.9.Postoperative scar score: the scar score of endoscopic surgery was lower than that of routine surgery(P<0.05).10.Multivariate correlation analysis showed that the operative time was positively correlated with the diameter of the lesion and the distance from the incision to the distal end of the lesion in the endoscopic surgery of single group(R~2=0.879,P<0.05).There was a linear correlation between the operation time and the number of lesions in the endoscopic surgery of multiple group(|r|=0.880,P<0.01).Conclusion:Both of the single port endoscopic breast tumor resection through axillary fold and routine operation are safe,reliable and effective.On the basis of on increase in surgical complications,endoscopic surgery has the advantages of hidden incision,small incision length,beautiful appearance,less intraoperative blood loss and high patients' satisfaction,which are not available in routine operation.It meets the requirements of young patients for physiological and psychological minimally invasive,and is worthy of clinical application.However,due to the long duration and high cost of the operation,the difficulty of the operation is related to the diameter of the lesion and the location of the lesion,so it is necessary to communicate with the patients in clinical application.The operation should be selected reasonably on the premise of fully understanding the patients' willingness and the difficulty of the operation.