上海市中西医结合学会甲乳外科专业委员会
中国中西医结合学会疡科专业委员会世界中医药学会联合会乳腺病专业委员会
中国医师协会介入医师分会超声介入专业委员会
中国抗癌协会肿瘤超声治疗专业委员会 中国超声医学工程学会超声治疗及生物效应专委会
国家卫生健康委继续教育与能力建设超声医学专家委员会治疗学组 上海市医师协会超声分会
上海市抗癌协会肿瘤消融治疗专业委员会
摘要 热消融术是一种针对乳腺良性病变的新型微创治疗方法，已证实其在乳腺良性肿瘤中的疗效。本指南综合分析
高质量临床证据，结合国内著名专家的临床经验与意见，经多次专家研讨达成共识。主要阐述乳腺良性肿瘤的热消融治
疗准则与操作规范，包括适应证、禁忌证、术前评估、麻醉方式、治疗类型及并发症处理等。同时，指南还强调了中医中药
在热消融诊治过程中的重要作用，提出了“中医五位一体”的综合治疗方案。本指南可为从事乳腺良性肿瘤治疗的医师
提供了重要的参考依据。
关键词 乳腺良性肿瘤; 热消融治疗; 中西医结合; 诊疗指南; 中医五位一体
Diagnosis and Treatment Guidelines for Benign Breast Tumors by Thermal Ablation with Integrated Traditional Chinese and Western Medicine Professional Committee of Thyroid and Breast Surgery，Shanghai Association of Chinese Integrative Medicine; Professional Committee of Ulcerology，Chinese Association of Integrative Medicine; Specialty Committee of Mammary Disease，World Federation of Chinese Medicine Societies; Committee of Interventional Ultrasound，Interventional Physician Branch，Chinese Medical Doctor Association; Tumor Ultrasound Therapy Committee，China Anti-Cancer Association; Special Committee of Ultrasound Therapy and Biological Effects，Chinese Association of Ultrasound in Medicine and Engineering; Treatment Group，Ultrasound Medical Expert Committee， National Health Commission Capacity Building and Continuing Education Center; Ultrasound Branch，Shanghai Medical Doctor Association; Tumor Ablation Therapy Committee，Shanghai Anti-Cancer Association
Abstract
Thermal ablation is a novel minimally invasive treatment for benign breast lesions，with confirmed efficacy in benign breast tumors． Based on a comprehensive analysis of high-quality clinical evidence，this guideline combines the clinical experience and opinions of renowned national experts，where consensus has been reached through multiple expert discussions． This guideline primarily outlines the treatment criteria and technical specifications of thermal ablation for benign breast tumors and related diseases，including indications，contraindications，preoperative assessment，anesthesia methods，treatment types，and complication management． Additionally，the guideline emphasizes the importance of traditional Chinese medicine( TCM) in thermal ablation，putting forward the comprehensive treatment plan of“TCM five-in-one”． This guideline provides an important reference for physicians engaged in benign breast tumor treatment．
Keywords
Benign breast tumor; Thermal ablation treatment; Integrated traditional Chinese and Western medicine; Diagnosis and treatment guideline; TCM five-in-one
中图分类号: Ｒ273
文献标识码: A
doi: 10． 3969 /j． issn． 1673 － 7202． 2025． 22． 002
Cem Sulu1 , Ipek Pervaz 2 , Turgut Gurer 3 , Dogan Yildiz 2 , Arzu Tas 3 , Ahmet Numan Demir 1 , Serdar Sahin1 , Hande Mefkure Ozkaya1 , Dildar Konukoglu 4 , Abdullah Tuten5 , Taner Damci 1 , Fahrettin Kelestimur 6 and Mustafa Sait Gonen 1*
1 Division of Endocrinology-Metabolism and Diabetes - Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye,
2Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye,
3Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye,
4Department of Biochemistry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye,
5 Department of Obstetrics and Gynecology, Cerrahpasa Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Türkiye,
6Department of Internal Medicine, Division of Endocrinology and Metabolic Diseases, Faculty of Medicine, Yeditepe University, Istanbul, Türkiye
Objective: To determine rate of polycystic ovary syndrome (PCOS) and its related features in women with prediabetes.
Methods: Of 3465 consecutive women applied between 2021 and 2023, 3218 women with diabetes mellitus or conditions affecting gonadal functions were excluded through digital screening and tele-interviews. Remaining 247 women underwent clinical assessments, excluding another 49 due to other endocrine diseases. The diagnosis of PCOS and prediabetes were based on Rotterdam and American Diabetes Association criteria, respectively.
Results: 100 women had prediabetes and 98 women had normoglycemia. The frequency of PCOS were 17% and 19.4% in prediabetes and control groups, respectively (p=0.715). The frequency of PCOS was 24% (6/25) in women with impaired glucose tolerance (IGT) only, 22.2% (2/9) in women with impaired fasting glucose only, and 15.5% (9/58) in women who met the HbA1C criterion only. Prediabetes group had higher insulin-like growth factor-1 (IGF–1) levels and lower anti-Müllerian hormone (AMH) levels (p<0.05). Insulin was correlated with testosterone, antral follicle count, and ovarian volume only in prediabetes group (p<0.05). Mediation models showed that insulin increased testosterone both directly and indirectly through increasing IGF-1 (b=0.4, p=0.0006).
Conclusion: While the rate of PCOS was not increased in overall prediabetes group, a trend for an increased risk in IGT subgroup only was noteworthy. Positive correlation of insulin with testosterone, antral follicle count, and ovarian volume being only found in prediabetes group suggested that prediabetes might render ovaries susceptible to the PCOS-like changes. The lower AMH in prediabetes implied the toxic effects of even mild hyperglycemia on ovaries.
KEYWORDS
hyperandrogenism, impaired fasting glucose, impaired glucose tolerance, insulin resistance, polycystic ovary syndrome, prediabetes
美国哈佛大学烧伤中心访问学者，全军烧伤专业委员会 常务委员，全国烧伤外科学分会青年委员会副主任委员，解放军医学杂志编委，中华烧伤杂志通讯编委。 擅长危重烧伤、颜面部烧伤、深度电烧伤和糖尿病足等难愈性创面治疗，特别是在疤痕与畸形整复方面经验丰富。
现任中华医学会创伤分会创面学组全国委员、中国医师学会烧伤分会全国委员、中华医学会烧伤分会青年委员、全军烧伤专业委员会委员、重庆市烧伤专业委员会委员、西南五省一巿烧伤整形学术委员会常委、中华烧伤杂志通讯编委、国家自然基金及SFDA新药评审专家、国外SCI杂志BURNS及Military Medicine等杂志审稿人等。
教授，烧伤科主任，博士生导师，国家级首批新世纪百千万人才工程人选、省烧伤外科专业委员会常委等。享受国务院特殊津贴。
管理治疗了大量烧烫伤、冻伤、电击伤、压疮及瘢痕患者，多次参与成批危重烧伤患者的救治工作。曾于国内外多所权威激光及整形治疗机构进修学习。
擅长： 各种烧伤治疗、表皮肿物去除和皮瓣成形、体表瘢痕防治，糖尿病足、褥疮、慢性难愈性创面的治疗；面部、胸部整形，自体脂肪移植。
从事整形、烧伤临床、教学、科研10年。2016年在中国科学院整形外科医院进修整1年，系统的学习了整形美容理论知识和临床手术技能。在国内第一作者发表论文6篇，参与发表论文20余篇，多篇为核心期刊。
伤口世界平台生态圈，以“关爱人间所有伤口患者”为愿景，连接、整合和拓展线上和线下的管理慢性伤口的资源，倡导远程、就近和居家管理慢性伤口，解决伤口专家的碎片化时间的价值创造、诊疗经验的裂变复制、和患者的就近、居家和低成本管理慢性伤口的问题。
2019广东省医疗行业协会伤口管理分会年会
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