乳腔镜辅助乳腺癌保乳和完全腔镜腋窝淋巴结清扫手术

目的　了解乳腔镜辅助保乳和完全腔镜腋窝淋巴结清扫治疗乳腺癌的临床总体效果。方法　 92例乳腺癌采用乳腔镜辅助、经乳晕入路的隐蔽小切口完成保乳 ,并完全腔镜腋窝淋巴结清扫。结果　术中冰冻切片病理检查提示 7例切缘不净 ,靠阳性边缘扩大切除 1 0cm宽的乳腺组织 ,再次送冰冻切片提示阴性。平均每例取出淋巴结 15 7个 ,3 9例病理显示腋窝淋巴结受累 ,平均受累 3 8个。平均手术时间 112 6min ,前期手术时间较长 ,后期手术时间明显缩短。保乳术后保留的乳房形态良好 ,乳腺切除创面 4例出现皮下积液 ,经抽吸加压包扎愈合。乳腔镜腋窝清扫术中出血很少 ,未出现手术并发症。乳晕切口和腋窝部位 3个trocar孔伤口小而隐蔽。术后平均随访 11 9个月 ,未见任何乳腺和腋窝复发迹象或trocar处种植 ,患者肩关节活动均良好。结论　借助乳腔镜器械 ,能通过乳晕处微小隐蔽切口及腋窝部 3个trocar孔 ,能比较顺利地完成乳腺癌肿的切除以及腋窝淋巴结微创清扫。

BREAST CONSERVING ASSISTED BY MASTOSCOPY AND ENTIRELY MASTOSCOPIC AXILLARY LYMPH NODE DISSECTION FOR THE PATIENT WITH BREAST CANCER

Objective: To study the general effects of breast?conserving assisted by mastoscopy and mastoscopic axillary lymph node dissection.Methods: 92 patients with breast cancer were treated with breast conserving assisted by mastoscopy and mastoscopic axillary lymph node dissection.Results: Frozen examination showed the positive margins in 7 cases, and these became negative by the enlarged resection of breast tissue with 1 0 cm wide. An average of 15 7 lymph nodes was removed. 39 patients had the involved nodes with a mean of 3 8 nodes positive per case. The operating duration was 112 6 min. The operating time was shortened for late patients than that for the earlier. Breast shapes were good after mastoscopy?assisted breast conserving. Subcutaneous accumulating liquid happened in 4 cases and disappeared by needle aspiration. The bleeding amount in mastoscopic axillary lymph node dissection was little. There was no operation complication. After a median follow?up time of 11 9 months, no relapse in breast and axilla or trocar site implantation had occurred. The shoulder mobilization of patients had unlimited. Conclusions: Breast conserving operation and axillary lymph node dissection can be smoothly accomplished with the help of mastoscopy.