Istagilov A Kh, Sigal E I, Khamidullin R G, Nagumanov E V, Gubaĭdullin Kh M
Clinical Oncological Center, Ministry of Health of the Republic of Tatarstan, Kazan.
Vopr Onkol. 2001;47(3):348-55.
Since extended mastectomy after Urban involves an unjustifiably high level of trauma, this method has limited application. We have evolved a procedure of video-assisted thoracoscopic parasternal lymphadenectomy (VATPL). On completion of the experimental part using cadavers to work out the rationale for extent of surgery, clinical trials started. A total of 120 operations in patients aged 27-73 were performed (left-sided--64, right-sided--56), with the number of lymph nodes removed in each case ranging 1-10. Metastases were detected in 23 (19.2%), isolated lesions (metastases to parasternal lymph nodes alone)--6 (5.0%). With volume of removed tissue being identical, the findings on level of pain, amount of narcotic analgetics, hospital stay duration, intra- and postoperative complication incidence and cardiointervalography and pneumotachometry for VATPL patients were significantly better than for those treated by traditional (open-chest) procedure. It is concluded that VATPL is a highly effective and low-traumatizing diagnostic method. It may be recommended as an operation of choice for parasternal lymph collector involvement of central or medial localization.
由于厄本（Urban）式扩大乳房切除术造成的创伤过大，不合理，因此该方法应用有限。我们研发了一种电视辅助胸腔镜胸骨旁淋巴结清扫术（VATPL）。在完成使用尸体进行的实验部分，确定了手术范围的理论依据后，开始了临床试验。共对120例年龄在27至73岁的患者进行了手术（左侧64例，右侧56例），每例切除的淋巴结数量为1至10个。发现23例（19.2%）有转移，孤立性病变（仅转移至胸骨旁淋巴结）6例（5.0%）。在切除组织量相同的情况下，VATPL患者在疼痛程度、麻醉性镇痛药用量、住院时间、术中和术后并发症发生率以及心电图和呼吸流速测量等方面的结果明显优于接受传统（开胸）手术的患者。结论是，VATPL是一种高效且低创伤的诊断方法。对于中央或内侧定位的胸骨旁淋巴结受累情况，可推荐将其作为首选手术。
