乳腔镜腋窝淋巴结清扫术的应用解剖

Applied Anatomy of Mastoscopic Axillary Lymph Node Dissection

乳腔镜腋窝淋巴结清扫手术不同于通常的腹腔镜手术,其手术操作空间较小,解剖层次复杂,腋窝部血管、神经、脂肪、淋巴组织多,手术技术要求高。以往的常规开放腋窝淋巴结清扫手术无法或难以识别的解剖结构可清晰暴露于腔镜视野下,使常规开放性手术水平得到提高。本文对肋间臂神经、腋静脉、肩胛下血管、胸背神经和血管、上臂淋巴回流途径、胸上腹静脉、胸长神经、胸外侧动脉、腋静脉胸小肌后段、胸大小肌间隙内和胸内侧神经等解剖结构的走行及在腔镜下的特征作了详细的描述。

The minimally invasive MALND differs from the usually laparoscopic operation. The narrow space, complicated anatomic layers, lots of blood vessels and nerves add much difficulty to the operation. Moreover, the elaborate anatomy in axilla becomes more clear by the help of the magnifying function of endoscopic system. Some anatomic structures which are difficult to be realized in conventional axillary lymph node dissection uncover under the endoscopic view. The routes and features under endoscopy of some anatomic structures such as intercostobrachial nerve, axillary vein, subscapular vessels, thoracodorsal nerve and vessels, lymphatic drainage channels, thoracic epigastric vein, long thoracic nerve, lateral thoracic arteries, axillary vein segment behind minor pectoralis and medial thoracic nerve in the space between major and minor pectoralis are described in detail.