术中导航系统在腔镜乳腺癌保乳根治术中的应用:病例报告

Application of intra-operative navigation in endoscopic breast conserving surgery:a case report

背景中国乳腺癌患者年轻化,年轻患者术后生活质量成为关注焦点。乳腺癌保乳手术在根治乳腺癌的同时保持乳房外形,我们中心是国内最早开展乳腺癌保乳精准手术的单位之一。腔镜微创技术是乳腺癌手术领域的新热点,但目前腔镜乳腺癌保乳手术的发展遭遇阻碍——难以精确勾画癌肿边缘。传统保乳手术中,癌肿切缘由术者手指触摸判断,这在腔镜操作下无法实现。为此,作者开展了全球首例腔镜下术中导航乳腺癌保乳术,应用术中导航系统精准定位癌肿边缘。患者信息患者为46岁女性,确诊为左侧乳腺癌,cT2N1M0 IIB期。患者保乳意愿强烈并要求术后乳房外形美观。方法应用乳房MR结果构建三维图像、术前O臂扫描乳房空间位置,再通过Medtronic Stealth Station S7手术导航系统将二者融合,构建出实时乳房三维模型。随后在导航系统的引导下,可用探针精准勾画肿瘤边缘,在腔镜下沿探针位置切下癌肿。结果病理结果提示肿瘤切缘组织未见癌,术后乳房两侧基本对称、正面观无伤口,患者对外形满意。讨论腔镜下术中导航乳腺癌保乳术提高了腔镜保乳手术的可操作性和切缘一次阴性率,有望将腔镜保乳手术大范围推广。

Background young age.The quality of life of young breast cancer patients has been a critical issue.Breast-conserving surgery(BCS)not only removes the tumor but also maintains the appearance of breast.The Breast Tumor Center of Sun Yat-sen Memorial Hospital is one of the first departments in China to perform breast-conserving surgeries.Endoscopic breast surgery has emerged as a promising surgical approach.However,it is hard to delineate the tumor margins in endoscopic BCS,which restrains its development.In traditional BCS,surgeons determine the tumor border by palpation,which is impossible in endoscopic BCS.For the first time,we performed the intra-operative navigation system-assisted endoscopic breast-conserving surgery,in which the tumor border was accurately delineated using the navigation system.PatientA 46-year-old woman was diagnosed with left breast cancer with the stage of cT2 N1 M0 IIB.She asked the surgeons to maintain the breast appearance to the greatest extent.MethodsBreast MR was performed to acquire the three-dimensional images.At the start of surgery,the spatial position of breast was acquired by scanning with O-arm device after skin preparation and draping.Then,we integrated the images and breast position in a real-time 3-dimensional model of Medtronic Stealth Station S7 Navigation System with the“3 D Fusion”function.Finally,we used the probe to precisely mark the tumor border and excised the lump.ResultsThe margins of the tumor were all negative in pathological assessment.The breasts looked basically symmetrical and the wound was invisible when viewed from the front.The patient was pleased with the appearance.DiscussionIntra-operative navigation system-assisted endoscopic breastconserving surgery achieves an easier operative procedure and a lower positive rate of surgical margin,which may vigorously promote the endoscopic BCS.