内镜腋窝探查及前哨淋巴结切除术。

Endoscopic axillary exploration and sentinel lymphadenectomy.

作者信息

Tsangaris T N, Trad K, Brody F J, Jacobs L K, Tsangaris N T, Sackier J M

机构信息

Department of Surgery, the Washington Institute of Surgical Endoscopy, and the Breast Care Center, The George Washington University, 2150 Pennsylvania Avenue, N.W., Washington, DC 20037, USA.

出版信息

Surg Endosc. 1999 Jan;13(1):43-7. doi: 10.1007/s004649900895.

DOI:10.1007/s004649900895

PMID:9869687

Abstract

BACKGROUND

Minimally invasive approaches have changed the practice of surgery in several specialties. The purpose of this study was to develop a reproducible endoscopic technique for the evaluation of the axilla in breast cancer patients.

METHODS

A total of 23 patients with biopsy-proven breast carcinoma were enrolled. Patients were positioned in the supine position with the ipsilateral arm abducted at 90 degrees. A 1-cm skin incision was made at the superior aspect of the axilla. Dissection was carried bluntly to the lateral border of the pectoralis major. A balloon distention device was inserted into the tract and distended under endoscopic vision to create a working space. Insufflation was initiated up to a pressure of 8 mmHg. A 30 degrees laparoscope was introduced for visualization of axillary contents. One or two additional 5-mm cannulas were placed as needed under direct visualization. Manipulation of axillary contents was performed, and in 19 patients a sentinel node identification technique was applied.

RESULTS

In all patients, using insufflation and minimal instrument dissection, the axillary vein, long thoracic, and thoracodorsal nerves were found in their usual anatomical locations. Utilizing blunt and sharp dissection, the axilla was thoroughly inspected, and individual lymph nodes were easily identified and extracted. In 11 of 19 patients, a sentinel node or blue dye was identified using isosulfan blue. There was a procedure concordance of 84%, and there were no complications.

CONCLUSIONS

We describe a novel endoscopic technique for the evaluation of the axilla in breast cancer patients. This technique allows (a) creation of a minimally invasive working space within the axilla, (b) recognition of key axillary anatomic landmarks, and (c) instrument manipulation within the axilla to identify and extract lymph nodes, and apply the sentinel node technique. This is the first report of a minimally invasive approach to axillary exploration to employ sentinel lymph node mapping.

摘要

背景

微创方法已经改变了多个专科的手术方式。本研究的目的是开发一种可重复的内镜技术，用于评估乳腺癌患者的腋窝。

方法

共纳入23例经活检证实为乳腺癌的患者。患者取仰卧位，患侧手臂外展90度。在腋窝上方做一个1厘米的皮肤切口。钝性分离至胸大肌外侧缘。将球囊扩张装置插入通道，并在内镜直视下扩张以创建工作空间。开始充气，压力达到8 mmHg。插入一个30度的腹腔镜以观察腋窝内容物。根据需要在直视下放置一到两个额外的5毫米套管。对腋窝内容物进行操作，19例患者应用了前哨淋巴结识别技术。