小切口保留乳头的乳房切除(NSM)腋窝淋巴结清扫即刻扩张器置入术  

Nipple-sparing mastectomy combined with tissue expander placement and axillary lymph node dissectionwithlateralmini-incision

作　　者：白雪 陈宏业 司惠妍 刘小涵 张提 Bai Xue;Chen Hongye;Si Huiyan;Liu Xiaohan;Zhang Ti(Department of General Surgery,The First Medical Center of Chinese PLA General Hospital,Bejing 100853,China;The School of Clinical Medicine,Nankai University,Tianjin 300071,China)

机构地区：[1]中国人民解放军总医院第一医学中心普通外科医学部乳腺外科,北京100853 [2]南开大学医学院,天津300071

出　　处：《中华普外科手术学杂志（电子版）》2023年第3期256-256,共1页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：团队自2016年开展乳腺癌外侧小切口保留乳头乳晕的乳房切除(NSM)腋窝淋巴结清扫即刻扩张器置入术,已累计完成200余例。本手术方式兼顾了安全性与美观性,提升了手术效率,无明显并发症,治疗效果满意。选取乳晕外侧稍弯向腋窝的弧形切口,长度不超过6 cm,使用电刀游离乳房皮瓣,冷刀切取乳头后侧切缘,进行术中冰冻病理检查。继续自胸大肌表面切除乳房腺体,使用超声刀清扫腋窝淋巴脂肪组织(Ⅰ水平和Ⅱ水平)。随后游离胸大肌后方组织,切断胸大肌肋骨侧止点,在确定乳头后切缘无癌浸润后,运用“双平面法”构建囊腔并放置组织扩张器,最后留置引流管并逐层缝合切口。The Nipple-sparing Mastectomy combined with Tissue Expander Implantation and Axillary Lymph Node Dissection with Lateral Mini-incision has been performed by our team since 2016,with more than 200 cases completed.This surgical method balances safety and aesthetics,improves surgical efficiency,and the therapeutic effect was satisfactory without significant complications.Firstly,a slightly curved arc incision is selected on the outside of the areola,extending no more than 6 cm in length.The breast skin flap is freed with an electrosurgical scalpel,and the posterior margin of the nipple is excised with a scalpel to check for cancer invasion by intraoperative frozen pathology.The breast gland is then excised from the surface of the pectoralis major,and the axillary lymphatic fatty tissue(Level I and I)is dissected using an ultrasonic scalpel.Subsequently,the tissue behind the pectoralis major is freed,and the lateral end of the pectoralis major rib is cut.After confirming that there is no cancerous infiltration on the cut margin behind the nipple,the tissue expander is placed using the dual-plane method to construct the cavity.Finally,two drainage tubes are left in place,and the incision is sutured layer by layer.

关 键 词：保留乳头乳晕的乳房切除术 腋窝淋巴结清扫术 植入物乳房重建 乳房扩张器置入术 

分 类 号：R737.9[医药卫生—肿瘤]