Nadkarni Mandar S, Raina Sudeep, Badwe Rajendra A
Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
ANZ J Surg. 2006 Jul;76(7):652-4. doi: 10.1111/j.1445-2197.2006.03791.x.
Surgery for breast cancer has evolved over the last century and has gone from limited to radical, extended radical and back to conservative surgery. Along this journey, one constant feature has been the necessity for a complete axillary dissection. In recent times, this concept has also been successfully challenged and now we are in an era of conservative or limited surgery in the axilla as well. These surgical procedures such as four-node axillary sampling or the technology-driven sentinel node biopsy are conservative axillary procedures and are often performed through very small incisions. With limited access to the surgical field, there is always an increased chance of inadvertent and unnecessary injury to surrounding vital anatomical structures such as nerves or blood vessels. A well-designed road map can definitely prevent such mishaps. This paper describes a simple technique of axillary surgery, which is step-wise and makes use of a relatively constant landmark, namely the medial pectoral pedicle, present within the axilla. Such a regimented systematic approach not only allows us to minimize the risks of complications during axillary surgery, but also enables us to train beginners easily and efficiently.
在过去的一个世纪里，乳腺癌手术不断发展，经历了从有限手术到根治性手术、扩大根治性手术，再回到保守手术的过程。在这一历程中，一个不变的特点是必须进行完整的腋窝淋巴结清扫。近年来，这一概念也受到了成功挑战，现在我们也处于腋窝保守或有限手术的时代。诸如四节点腋窝采样或技术驱动的前哨淋巴结活检等手术操作都是保守的腋窝手术，通常通过非常小的切口进行。由于手术视野有限，对周围重要解剖结构如神经或血管造成意外和不必要损伤的几率总是会增加。精心设计的路线图肯定可以防止此类事故发生。本文描述了一种简单的腋窝手术技术，该技术循序渐进，并利用腋窝内相对恒定的标志，即胸内侧蒂。这种规范的系统方法不仅能让我们在腋窝手术期间将并发症风险降至最低，还能使我们轻松、高效地培训初学者。
