腔镜手术在乳腺疾病外科治疗中的应用

目的 探索乳腺疾病腔镜手术的方法、意义和存在的问题。方法 行腔镜乳腺癌改良根治术5例,腔镜辅助小切口改良乳腺癌根治术30例,腔镜辅助保留乳房的乳腺癌切除术加腋窝淋巴结清扫术13例。2例乳腺多发性纤维腺瘤和2例乳腺囊性增生病伴不典型增生行腔镜全乳切除术一期假体植入术,7例乳腺囊性增生病伴不典型增生和16例男性乳房发育症患者行腔镜皮下乳房切除术。1例10月大婴儿巨大胸壁淋巴管瘤行经腋窝腔镜辅助肿瘤切除术。结果 全部病人均顺利完成手术,手术历时180～360min。腔镜辅助小切口改良乳腺癌根治术和腔镜辅助保留乳房的乳腺癌切除术皮肤和乳腺切缘冰冻切片检查均为阴性。2例术后有切口内出血,1例腋窝切口皮缘坏死,1例保留乳房手术乳房切口皮缘坏死,4例乳头表皮坏死,仅1例乳头表面皮肤全层坏死,其余病人术后恢复顺利。结论 乳腺疾病腔镜手术改变了传统手术方法,具有常规手术无法达到的良好的美容效果。

Application of endoscopy-assistant operation in surgical treatment of breast diseases

Objective To explore the technique and problems of endoscope-assistant breast surgery. Methods Five patients with breast cancer underwent endoscope-assistant modified radical mastectomy, 30 patients with breast cancer underwent endoscope-assistant modified radical mastectomy with small incision, and 13 patients with breast cancer underwent endoscope-assistant resection of breast cancer with retained breast plus axillary lymph node dissection. Two patients with fibroadenoma and 2 patients with fibrocystic disease breast with atypical hyperplasia were treated with endoscope-assistant subcutaneous total mastectomy and breast reconstruction by one-stage silica gel filling operation. Seven patients with fibrocystic disease with atypical hyperplasia and 16 patients with gynecomastia were treated with endoscope-assistant subcutaneous total mastectomy. One 10-month-old infant with huge chest lymphangioma was treated with endoscope-assistant tumor resection via axilla. Results All operations were performed smoothly. The duration of operation was 180~360 min. The frozen sections of skin and breast tissue at the incision margin resected during operation endoscope-assistant modified radical mastectomy with small incision and endoscope-assistant conservative surgery were all negative There were 2 cases of postoperative incisional bleeding, 1 case of skin margin necrosis of axillary incision, 1 case of skin margin incisional necrosis after endoscope-assistant resection of breast cancer with retained breast plus axillary lymph node dissection, 4 cases of epidermal necrosis of nipple, and one case of full thickness skin necrosis of nipple surface. Conclusion~Endoscope- assistant breast surgery has changed the routine method in breast operation and manifests the cosmetic effects that cannot be achieved by routine surgery.