摘要
溶脂法与非溶脂法腔镜腋窝淋巴结清扫在乳腺癌手术中的应用存在争议,也在不断的发展。非溶脂法腔镜腋窝淋巴结清扫在获得与溶脂法同样的腔镜放大视野、精细操作以及微创效果的同时,更符合常规开放手术中腋窝淋巴结处理的手术顺序,不受限于淋巴结大小,完整切除腋窝淋巴脂肪组织,可经乳晕切口顺畅取出手术标本,除了无法应用于内下象限肿瘤的保乳手术外,其避免了溶脂法腔镜腋窝淋巴结清扫的争议点。手术时间的延长及部分乳腺外科医生缺乏腔镜基础训练是限制非溶脂腔镜腋窝淋巴结清扫广泛应用的主要因素,相信随着手术器械的不断进步及外科规培制度的落实,这一技术会有更广阔的应用空间。
There is controversy but constantly developments in creation the working space for endoscopic axillary lymph node dissection using liposuction or non-liposuction.The nonliposuction method can obtain the same good vision for endoscopic operation as well as the liposuction methods,with same benefit in thorough manipulation and minimally invasiveness.Besides,it fits the routine procedure of open surgery,with no limit to the size of the lymph nodes.It can also provide a total removal of lymphatic fat tissue,and the specimens can be easily removed trough the peri-areolar incision.The non-liposuction method almost overcome all the disputes of liposuction method,except the lack of use in breast conservative surgery for tumors located in the lower inner quadrant.For breast surgeons with proficient laparoscopic techniques,endoscopic handling for sentinel lymph node biopsy or axillary lymph node dissection is technically sufficient.However,the understanding of axillary fascia levels and breast aesthetics is even more important.The extension of surgical time and the lack of laparoscopic training for some breast surgeons are the main factors restricting the wide application of endoscopic axillary lymph node procedures with non-liposuction.However,with the progress of surgical instruments and the implementation of surgical standardized resident training the procedure is believed to have a wider application.
作者
杨为戈
倪小健
YANG Wei-ge;NI Xiao-jian(Department of Breast Surgery,Fudan University Affiliated Zhongshan Hospital,Shanghai 200032,China)
出处
《中国实用外科杂志》
CSCD
北大核心
2020年第10期1143-1146,共4页
Chinese Journal of Practical Surgery
基金
国家自然科学基金(No.81702586)。
关键词
乳腺癌
腔镜
腋窝淋巴结清扫
溶脂法
非溶脂法
breast cancer
endoscopy
axillary lymph node dissection
liposuction
non-liposuction
