新辅助化疗后左乳腺癌改良根治术  

Modified radical resection of left breast cancer after neoadjuvant chemotherapy

作　　者：齐立强 Qi Liqiang(Department of Breast Surgery,Shaanxi Province Cancer Hospital/Shaanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences,Taiyuan Shaanxi Province 030013,China)

机构地区：[1]中国医学科学院肿瘤医院山西医院乳腺外科,太原030013

出　　处：《中华普外科手术学杂志（电子版）》2023年第3期257-257,共1页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：(1)切口。平行四边形法或S形,内至胸骨左缘,外至腋前线,上至锁骨下缘,下至肋弓上缘,均约1 cm。(2)冷刀剥离皮瓣。皮瓣游离在乳房组织浅筋膜浅层进行,分离中保留真皮下血管网,选择较低输出功率以减少热损伤。(3)腺体切除。在胸大肌上分离出腺体组织,用纱布包起被剥离的腺体,利于腋窝清扫扩大术野。术中应避免损伤胸大肌纤维,结扎或电凝止血胸廓内动脉穿支动脉及从胸大肌穿出的多支细小穿支血管。(4)腋淋巴结分期。分离保护腋静脉,结扎分支。双极电刀清扫第三水平淋巴结后继续解剖腋窝,保护胸长神经、胸背神经。(5)胸肌间淋巴结清扫(Rotter淋巴结)。锐性分离胸大、小肌间的间隙以完成该区域淋巴结清扫。(6)止血冲洗。腋下和胸骨旁各放置1根多孔引流管,抽吸引流管为负压状态。(1)Incision.It is recommended to use the parallelogram method or S shape,inside to the left margin of the sternum,outside to the anterior axillary line no more than the anterior axillary line,about 1cm above the lower margin of the clavicle,and about lcm below the upper margin of the costal arch.(2)Cold knife peel the flap.Flap dissociation should be carried out in the superficial layer of the superficial fascia of the breast tissue,and the subdermal vascular network should be preserved during the separation process:As far as possible,low output power should be selected to reduce thermal damage.(3)glandulectomy.After the completion of flap dissociation,glandular tissue was separated from the pectoralis major muscle,and the peeled glands were wrapped with clean gauze,which was conducive to axillary dissection and enlargement.Intraoperative damage to pectoralis major fibers should be avoided,and attention should be paid to ligation or electrocoagulation of the perforator artery of the internal thoracic artery and many small perforator vessels from the pectoralis major muscle.(4)axillary lymph node staging.The protective axilary vein was separated and its branches ligation.After the third level lymph nodes were dissected by bipolar electrotome,the axilla was dissected to protect the long thoracic nerve and the thoracolumdoric nerve.(5)Interthoracic lymph node dissection(Rotter lymph node):sharp separation of the space between the large and small thoracic muscles to complete lymph node dissection in this region.(6)Careful hemostatic irigation.One porous drainage tube was placed under the axilla and one beside the sternum,and the suction tube was in a negative pressure state.

关 键 词：乳腺肿瘤 新辅助化疗 乳房切除术 改良根治性 

分 类 号：R737.9[医药卫生—肿瘤]