全腔镜乳房皮下腺体切除术联合腔镜前哨淋巴结活检术治疗早中期乳腺癌的技巧探讨

摘要

目的：观察全腔镜乳房皮下腺体切除术联合腔镜前哨淋巴结活检术（SLNB）治疗早中期乳腺癌的近期疗效和安全性，探讨手术技巧。方法：选取行2～4周期 TEC 方案新辅助化疗方案的早中期乳腺癌患者63例为研究对象，实施腔镜乳房皮下腺体切除术联合腔镜 SLNB，并对前哨淋巴结转移病例进一步行腔镜腋窝淋巴结清扫。记录术中前哨淋巴结活检结果、手术效果、术后并发症和复发、转移情况。结果：63例患者前哨淋巴结检出率100％（63／63），获取前哨淋巴结1～8枚，平均（3．5±0．7）枚，其中32例 SLNB 阳性者行腔镜腋窝淋巴结清扫术。术后并发症主要为乳头部分坏死4例、3例皮下气肿。术后随访平均（7．6±2．1）个月，无局部复发和远处转移。结论：全腔镜乳房皮下腺体切除术联合 SLNB 治疗早中期乳腺癌安全可行，良好的操作空间、充分溶脂、保护乳头乳晕处皮肤和皮下血运是手术成功的关键。%Objective:To observe the clinical efficacy of endoscopic-assisted subcutaneous mastectomy and sentinel lymph node biopsy (SLNB)in treatment of early and medium stage breast cancer,and to discuss related surgery management.Methods:A total of 63 patients with early and medium stage breast cancer were given endoscopic-assisted subcutaneous mastectomy and SLNB after 2-4 cy-cles TEC neoadjuvant chemotherapy before operation,and node metastasis cases further endoscopic axillary lymph node dissection for sentinel lymph.The results of sentinel lymph node biopsy,surgical efficacy,complication,recurrence and metastasis of cancer were re-corded and analyzed in surgery.Results:The identification rate of sentinel lymph node was 100%(63 /63),with an average of (3.5 ± 0.7)nodes (1 -8).Axillary lymph node dissection was performed in 32 cases with positive SLNB.The main complications were partial nipple necrosis in 4 cases and subcutaneous emphysema in 3 cases.With an averaged (7.6 ±2.1 )months of follow up,none of patients had recurrence or metastasis of cancer.Conclusion:Endoscopic-assisted subcutaneous mastectomy and SLNB is feasible and safe in treatment of early and medium stage breast cancer.Proper operation space,sufficient fat-dissolving and carefully protection on the nipple areola skin and subcutaneous blood circulation is the key to successful operation.