A opera sau nu tumorile mamare
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Transcript of A opera sau nu tumorile mamare
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TRATAMENTUL CHIRURGICAL
AL TUMORILOR MAMARE
Cristian Viisoreanu, Teodor Buliga
Hyperclinica Medlife/Life Memorial Hospital
Bucuresti
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•Diagnosticul precoce atrage si sanctiuni terapeutice mai blande•Programele de screening pot descoperi leziunile mamare in stadii incipiente•Screeningul mamografic descopera peste 75% din cancerele mamare la pacientele cu varsta de 40-45 ani
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Diagnosticul patologiei mamare:
-Examen clinic
-Examene paraclinice:
-Mamografie clasica si digitala
-Ecografia 2D, 3D si ecografia cu substanta
de contrast
-Elastografia
-IRM
-PET/CT
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Ecografia cu substanta de
contrast-Se utilizeaza SONOVUE (hexaflorura de sulf)
-Se administreaza intravenos
-Se elimina pulmonar (se poate administra la paciente
cu insuficienta renala, hepatica),
-contraindicatie relativa la pacientele cu astm bronsic si
BPOC
-Contraindicatii absolute: hiperesensibilitate la
hexaflorura de sulf, sindrom coronarian acut, BCI
instabila, hipertesiune pulmonare severa, sunturi
dreapta-stanga, SDRA, sarcina,
-Se administreaza la persoane cu varsta > 18 ani
-Timp de actiune : 5-10 min
-Reactii adverse: cefalee, greata, parestezii, eritem
facial, durere la locul injectarii si pe traseul venos.
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-Se administreaza 5ml SONOVUE
(bolus) + 10ml ser fiziologic
-Se urmareste tumora in:-Faza arteriala – 10-40 sec
-Faza venoasa – 40-120sec
Ecografia cu substanta de contrast
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Patologia mamara benigna
-Hipertrofia/hipotrofia mamara
Se opereaza sau nu?-Tratament medicamentos pentru reglarea
dispunctie ovariene sau corticosuprarenale
-Tratament chirurgical: nu inainte de completa
incheiere a pubertatii
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•Mastita acuta/abcesul sanului
Se opereaza sau nu?•Tratament antibiotic : dupa examen
bacteriologic si antibiograma
•Tratament chirurgical : incizie/drenaj; excizie
sectorala larga, dupa stingerea procesului acut
Patologia mamara benigna
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•Galactocelul
Se opereaza sau nu?•Tratament conservator (evacuarea continutului)
cu risc mare de recidiva si formarea unui abces
mamar.
•Tratamentul chirurgical - excizie
Patologia mamara benigna
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•Papilomul intraductal si sindromul de mamela
secretanta
Se opereaza sau nu?•Tratament medicamentos
•Tratament chirurgical – excizii sectorale cu
examen histopatologic
Patologia mamara benigna
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•Tumora Phyllodes
Se opereaza sau nu?•Tratament chirurgical
–Excizii sectorale
–Mastectomie radicala+/- limfadenectomie pentru
cazurile cu degenerare sarcomatoasa
Patologia mamara benigna
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•Fibroadenomul mamar
Se opereaza sau nu?•Tratament medicamentos pentru
fibroadenoamele < 1cm
•Tratament chirurgical pentru fibroadenoamele >
1cm
Patologia mamara benigna
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•Fibroadenomul
•Tratament chirurgical clasic
•Tratament minim invaziv prin vacuum aspiratie
sau tehnica INTACT BLES, ambele sub
anestezie locala si ghidaj ecografic
Patologia mamara benigna
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•Mastoza chistica
•Cea mai frecvanta leziune patologica intilnita
in practica
•Leziune precursoare ce se asociaza frecvent cu
leziuni maligne.
Se opereaza sau nu?
Patologia mamara benigna
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•Mastoza chistica
•Forma usoara – tratament medicamentos
•Forma medie tratament
medicamentos/chirurgical (punctie aspirativa cu
ac fin, sub ghidaj ecografic si anestezie locala,
tratament prin vacuum aspiratie, excizie
sectorala)
•Forma avansata – tratament chirurgical
Patologia mamara benigna
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•Tratamentul chirurgical recomandat in
majoritatea cazurilor de cancer mamar, in functie
de stadiu
•Tratamentul chirurgical cuprinde:–Rezectia mamara limitata cu limfadenectomie
axilara
–Mastectomia radicala modificata tip Madden,
Patey, etc.
–Reconstructia mamara imediata sau tardiva (diverse
procedee)
Patologia mamara maligna
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•Cu multumiri