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
原创： 十六点五 中山二院糖尿病足中心
大趾是足部最重要的结构，如果被切除，对足部的功能会有比较大的影响，因此，应该尽可能的保存。
感染的足趾是比较常见的一种糖尿病足表现形式，能否保全足趾是一个比较有技巧的工作，现举例说明
原创： 胡海涛 负压引流与创面修复
刚毕业那会经常遇到感染性伤口和压疮患者，能做的就是勤快换药，幻想有一种伤口持续吸引多好，就可以解决每天换药的问题，也可以减轻患者的疼痛——当时还不知道有封闭式负压引流这个技术！
原创： 胡大夫 负压引流与创面修复
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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