乳腺腔镜腋窝手术中的持镜技巧及思考  

Skills of holding camera in endoscopic axillary surgery of mammary glands and the considerations

作　　者：朱燕雯 张普生[1] 黄红颜 罗云峰[1] ZHU Yanwen;ZHANG Pusheng;HUANG Hongyan;LUO Yunfeng(Department of Breast Surgery,General Surgery Center,Zhujiang Hospital of Southern Medical University,Guangzhou 510280,China)

机构地区：[1]南方医科大学珠江医院普通外科中心乳腺外科,广州510280

出　　处：《中国临床新医学》2024年第10期1109-1113,共5页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：广州市临床特色技术项目(编号:2023P-TS23);南方医科大学珠江医院医疗新技术项目(编号:202101001,XJS202301001);北京“新锐肿瘤支持治疗课题研究”项目(编号:cphcf-2022-076)。

摘　　要：目的总结与思考持镜助手在腔镜腋窝前哨淋巴结活检及淋巴结清扫术中的配合技巧,为乳腺腔镜在腋窝前哨淋巴结活检及淋巴结清扫术中的顺利开展提供理论和技术支持。方法分析2022年7月至2023年6月于南方医科大学珠江医院普通外科中心乳腺外科行腔镜腋窝手术的154例乳腺癌患者的临床资料,行腔镜腋窝前哨淋巴结活检术96例,行腔镜腋窝淋巴结清扫术58例。持镜助手术前调整镜头清晰度至最佳,并协助进行荧光前哨淋巴结定位。术中清晰暴露前哨淋巴结及其相连的淋巴管,将行腋窝淋巴结清扫者的肋间臂神经及腋静脉保持于视野水平位,镜头随超声刀移动避免误伤。结果154例均在腔镜下完成手术,无中转开放手术。腋窝前哨淋巴结活检腔镜操作时间10~46(21.02±7.03)min,腋窝淋巴结清扫腔镜操作时间30~85(59.90±14.23)min。腔镜下操作无明显出血,术中镜头清洗3~12(5.21±2.52)次。结论乳腺腔镜手术的顺利开展需要术者与持镜助手配合默契。优秀的持镜助手不仅需要熟悉乳腺及腋窝解剖结构、手术操作等基本知识,而且要掌握一定持镜配合技巧,才能有效协助术者,保证手术进程安全、高效。Objective To summarize and consider the coordination skills of the camera-holder assistant in endoscopic axillary sentinel lymph node biopsy and lymph node dissection,and to provide theoretical and technical support for the smooth implementation in endoscopic axillary sentinel lymph node biopsy and lymph node dissection.Methods The clinical data of 154 patients undergoing endoscopic axillary surgery in Department of Breast Surgery,General Surgery Center,Zhujiang Hospital of Southern Medical University from July 2022 to June 2023 were analyzed.Among the 154 patients,96 patients underwent endoscopic axillary sentinel lymph node biopsy and 58 patients underwent endoscopic axillary lymph node dissection.Before the surgery,clarity of the lens was adjusted to the best and fluorescent sentinel lymph node localization was performed by the camera-holder assistant.During the operation,sentinel lymph nodes and lymphatic vessels connected to the sentinel lymph nodes were clearly exposed,and the intercostal brachial nerve and axillary vein were kept at visual field level in the patients undergoing axillary lymph node dissection,and the lens were moved with the ultrasonic knife to avoid accidental injury.Results All the 154 patients were completed surgery under endoscope,and no patients were transferred to open surgery.The endoscopic operation time for axillary sentinel lymph node biopsy was 10-46(21.02±7.03)minutes,and the endoscopic operation time for axillary lymph node dissection was 30-85(59.90±14.23)minutes.No obvious bleeding was observed during the operation under endoscope.The lens of the endoscope were cleaned 3-12(5.21±2.52)times.Conclusion The successful process of endoscopic breast surgery requires the tacit cooperation between the surgeon and the camera-holder assistant,and an excellent camera-holder assistant not only needs to be familiar with the basic knowledge of anatomical structure of the mammary glands and axilla,and the surgical procedure,but also needs to master the collaboration skills of holding cam

关 键 词：乳腺腔镜 腋窝手术 持镜助手 前哨淋巴结活检 淋巴结清扫 

分 类 号：R615[医药卫生—外科学]