运用局部肿胀技术切除腋窝淋巴结的术式探讨

目的改进乳腺癌术中腋窝淋巴结清扫的手术方式，减少术后并发症及局部畸形的发生。方法118例乳腺癌患者随机分为改良组和对照组。改良组应用肿胀技术充盈腋筋膜使腋窝各壁与腋筋膜的界限清晰，血管神经与淋巴结之间间隙增宽，清扫中有利于保护血管神经免受损伤；同时保留了完整的腋窝壁减少术后局部畸形的发生；应用生物蛋白胶进行创面涂抹闭合开放的小血管和淋巴管。结果改良组术后局部疼痛、患肢功能障碍、患肢淋巴水肿、腋窝积液和腋窝畸形程度等的发生均明显低于对照组。结论应用腋窝肿胀技术可有效保护血管神经和腋窝周壁的完整，生物蛋白胶局部应用可有效闭合开放的血管和淋巴管，从而减少术后局部畸形和并发症的发生，促进伤口愈合。

The operation approaches of minimally invasive ALND in breast cancer patients

Objective To improve the surgical procedures of ALND,reduce postoperative complications and the occurrence of local abnormalities.Methods Tumescent technique was used to engorge axillary fascia,make the limit of armpit clear,widen the interspace between blood vessel,nerves,and lymph node,reserve the integrity of armpit,reduce postoperative local abnormalities.By using fibrin glue,the raw surface was besmeared to close small vessels and lympgatic vessels,avoiding postoperative local fluidify and promoting intention.Results The incidence of postoperative pain,functional disturbance,lymphedema,armpit fluidify was lower and the degree of armpit abnormalities milder in experiment group than in control group.Conclusion Utilizing tumescent technique can protect blood vessels,nerves and reserved the integrity of armpit effectively,while utilizing fibrin glue can close the open blood vessels and lympgatic vessels,as a result can reduce postoperative local abnormalities and postoperative complications,thus promoting intention.