非溶脂全腔镜腋窝淋巴结和乳房皮下腺体切除术的应用技巧探讨  

Exploration on application skills of non-lipolytic total endoscopic axillary lymph node and breast subcutaneous gland resection surgery

作　　者：黄雨 罗云峰 朱燕雯 朱迪 黎梦云 HUANG Yu;LUO Yunfeng;ZHU Yanwen;ZHU Di;LI Mengyun(Department of Thyroid Breast and Vessel Surgery,Southern Medical University Hospital of Integrated Traditional Chinese and Western Medicine,Guangzhou 510315,China;Department of Breast Surgery,General Surgery Center,Zhujiang Hospital of Southern Medical University,Guangzhou 510282,China)

机构地区：[1]南方医科大学中西医结合医院甲乳血管外科,广州510315 [2]南方医科大学珠江医院普通外科中心乳腺外科,广州510282

出　　处：《中国临床新医学》2024年第10期1103-1108,共6页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：广州市临床特色技术项目(编号:2023P-TS23)。

摘　　要：目的探讨非溶脂全腔镜腋窝淋巴结和乳房皮下腺体切除术的应用技巧。方法总结南方医科大学中西医结合医院甲乳血管外科2022年7月至2023年12月收治的接受非溶脂全腔镜腋窝淋巴结和乳房皮下腺体切除术的59例女性乳腺癌患者的临床资料,其中11例因前哨淋巴结阳性需行腔镜腋窝淋巴结清扫术,对获取腋窝淋巴结数目、手术时间、乳头皮肤情况、上肢感觉异常及运动功能障碍进行评估。结果所有患者均成功完成非溶脂腔镜前哨淋巴结活检和乳房皮下腺体切除术。每例获取前哨淋巴结2~8枚,平均4.2枚,共计210枚。11例行腔镜腋窝淋巴结清扫术。2例术后乳头轻微结痂,1个月后干痂脱落而未见乳头缺损。6例出现轻度皮下积液,经按摩驱赶积液后改善,无患侧上肢感觉异常及运动功能障碍发生。随访8~15个月(平均10.3个月),未见局部复发和远处转移。结论非溶脂全腔镜腋窝淋巴结和乳房皮下腺体切除术操作顺畅,简单易学,并发症少,是即时乳房重建的必要手术,也为个性化外科治疗提供一种选择。Objective To explore the application skills of non-lipolytic total endoscopic axillary lymph node and breast subcutaneous gland resection surgery.Methods The clinical data of 59 female patients with breast cancer who were admitted to Department of Thyroid Breast and Vessel Surgery,Southern Medical University Hospital of Integrated Traditional Chinese and Western Medicine and received non-lipolytic total endoscopic axillary lymph node and breast subcutaneous gland resection surgery from July 2022 to December 2023 were summarized.Among the 59 patients,11 patients underwent endoscopic axillary lymph node dissection due to sentinel lymph node positive.The obtained number of axillary lymph nodes,surgical time,nipple skin condition,upper limb sensory abnormalities,and motor dysfunction were evaluated.Results The non-lipolytic endoscopic sentinel lymph node biopsy and breast subcutaneous gland resection surgery were successfully completed in all the patients.Two to eight pieces of sentinel lymph nodes were obtained in each case,with an average of 4.2 pieces in each case and a total of 210 pieces in all the 59 cases.Endoscopic axillary lymph node dissection was performed in 11 cases.Two patients had slight papillae scab after surgery,which shed 1 month later,and no nipple damage was observed.Six patients had mild subcutaneous effusion,which improved after massage to drive away the effusion,and no paresthesia or motor dysfunction occurred on the affected upper limbs.The patients were followed up for 8 to 15 months and the average was 10.3 months without local recurrence and distant metastasis.Conclusion Non-lipolytic total endoscopic axillary lymph node and breast subcutaneous gland resection surgery is a smooth operation,simple and easy to learn,with fewer complications.It is a necessary operation for immediate breast reconstruction,and also provides one more option for personalized surgical treatment.

关 键 词：乳腺癌 腔镜手术 腋窝淋巴结 皮下腺体切除术 机器人手术 

分 类 号：R737.9[医药卫生—肿瘤]