Yamashita K, Shimizu K
Department of Surgery, Nippon Medical School Musashikosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan.
Surg Endosc. 2008 Feb;22(2):392-7. doi: 10.1007/s00464-007-9407-5. Epub 2007 May 24.
Video-assisted breast surgery (VABS) is a less invasive and aesthetically better option for benign and malignant breast diseases and for sentinel lymph node biopsy (SLNB). The authors have performed 150 VABS procedures since December 2001. They have examined the usefulness of three-dimensional computed tomographic (3D-CT) lymphography for detecting sentinel lymph nodes (SLNs) precisely, as well as the cosmetic and treatment results of VABS.
In this study, VABS was performed with a 2.5-cm skin incision in the axilla or periareola (1 cm in the axilla for SLNB), using a retraction method, for mammary gland resection, SLNB, axillary lymph node dissection, and breast reconstruction under video assistance. On the day before the surgery, 3D-CT lymphography was performed to mark SLN on the skin. Above the tumor and near the areola, 2 ml of Iopamiron 300 was injected subcutaneously. A 16-channnel multidetector-row helical CT scan image was taken after 1 min and reconstructed to produce a 3D image. Sentinel lymph node biopsy was performed by the VABS technique using the Visiport.
The VABS procedure was performed for 19 benign and 131 malignant diseases, and 115 SLNBs (74 with 3D-CT) were performed. The SLNs were shown precisely by 3D-CT lymphography, as proved by a case of lymph node metastasis, in which accurate relationships between lymph ducts and SLNs were shown. These were classified into four patterns: a single duct to single node (40 cases), multiple ducts to a single node (13 cases), a single duct to multiple nodes (1 case), and multiple ducts to multiple nodes (12 cases). The SLNB procedure can be performed safely by 3D-CT lymphography and less invasively by VABS.
The findings show that 3D-CT lymphography is useful for performing precise SLNB using VABS.
电视辅助乳腺手术（VABS）对于良性和恶性乳腺疾病以及前哨淋巴结活检（SLNB）而言，是一种侵入性较小且美观效果更佳的选择。自2001年12月以来，作者已开展了150例VABS手术。他们研究了三维计算机断层扫描（3D-CT）淋巴造影术在精确检测前哨淋巴结（SLN）方面的实用性，以及VABS的美容和治疗效果。
在本研究中，VABS通过在腋窝或乳晕处做2.5厘米的皮肤切口（用于SLNB时腋窝切口为1厘米），采用牵拉方法，在电视辅助下进行乳腺切除、SLNB、腋窝淋巴结清扫和乳房重建。手术前一天，进行3D-CT淋巴造影术以在皮肤上标记SLN。在肿瘤上方和乳晕附近，皮下注射2毫升碘帕醇300。1分钟后进行16通道多层螺旋CT扫描成像，并重建以生成三维图像。使用Visiport通过VABS技术进行前哨淋巴结活检。
VABS手术用于19例良性疾病和131例恶性疾病，共进行了115例SLNB（74例采用3D-CT）。3D-CT淋巴造影术精确显示了SLN，一例淋巴结转移病例证明了这一点，该病例显示了淋巴管与SLN之间的准确关系。这些分为四种模式：单管至单节点（40例）、多管至单节点（13例）、单管至多节点（1例）和多管至多节点（12例）。通过3D-CT淋巴造影术可安全地进行SLNB手术，而VABS则侵入性较小。
研究结果表明，3D-CT淋巴造影术有助于使用VABS进行精确的SLNB。
