腔镜技术在腋窝淋巴结清扫及带蒂大网膜一期重建乳房的应用  

Application of endoscopic techniques in axillary lymph node dissection and immediate breast reconstruction using pedicled greater omental flap

作　　者：罗云峰[1] 张普生[1] 黄宗海[1] 邓鉴文[1] 邵国利[1] 韩帅[1] 

机构地区：[1]南方医科大学珠江医院普通外科,广东广州510282

出　　处：《中国普通外科杂志》2014年第11期1460-1466,共7页China Journal of General Surgery

摘　　要：目的:探讨应用腔镜技术行腋窝淋巴结清扫及带蒂大网膜重建乳房的临床效果。方法:分析35例行微创根治+微创乳房重建的Ⅰ、Ⅱ期乳腺癌患者资料,患者先行腔镜腋窝淋巴结清扫术+腔镜辅助肿瘤所在象限腺体切除,然后采用腹腔镜获取的带蒂大网膜经皮下隧道即时重建乳房。结果:手术平均总时间为318 min,其中腔镜腋窝淋巴结清扫平均时间为41 min,腹腔镜大网膜获取平均时间为59 min,术中平均出血量为75 mL(主要为腺体部分切除时出血)。1例患者术中损伤胃网膜动脉后改为仅用1条大网膜动脉做为蒂部血管作为供血,术后出现大网膜部分坏死;1例患者出现切口脂肪液化;余患者大网膜成活,无腹部并发症,腋窝形态及上肢功能良好。乳房美学评价,28例优,6例良,1例一般。结论:腔镜腋窝淋巴结清扫联合腹腔镜带蒂大网膜获取进行一期重建乳房安全可行,手术达到较好的微创效果与美观要求。Objective：To assess the clinical effect of application of endoscopic techniques in axillary lymph node dissection and pedicled greater omental flap breast reconstruction.Methods：The data of 35 patients with stage I and II breast cancer undergoing minimally invasive radical resection plus minimally invasive breast reconstruction were analyzed.The patients underwent endoscopic axillary lymph node dissection and endoscopically assisted tumor quadrantectomy first,and then immediate breast reconstruction by the laparoscopically harvested pedicled greater omental flap through subcutaneous tunnel was performed.Results：The average time for the entire operation was 318 min,in which,the average time for endoscopic axillary lymph node dissection was 41 min,and for laparoscopic pedicled greater omental flap harvest was 59 min,and the average intraoperative blood loss was 75 mL（largely during mastectomy）.One case developed partial omental necrosis because the gastroepiploic artery was injured during the operation and only one omental artery was used instead for blood supply to pedicle flap,fat liquefaction of the incision occurred in one case,and in the remaining cases,the greater omental flap survived;no abdominal complications occurred,and the axillary shape as well as upper limb function were satisfactory.The cosmetic outcome was ＂excellent＂ in 28 cases, ＂good＂ in 6 cases,and ＂fair＂ in one case.Conclusion：The endoscopic axillary lymph node dissection combined with laparoscopically harvested pedicled omental flap for immediate breast reconstruction is safe and feasible,and the procedure achieves better results for minimal invasion and aesthetic requirements.

关 键 词：乳腺肿瘤/外科学 淋巴结切除术 网膜 乳房成形术 

分 类 号：R737.9[医药卫生—肿瘤]