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

doi:10.3969/j.issn.1009-976X.2022.01.001

岭南现代临床外科 ›› 2022, Vol. 22 ›› Issue (01): 1-5.DOI: 10.3969/j.issn.1009-976X.2022.01.001

• 外科创新 • 下一篇

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

欧欣瑜, 陆艺文, 刘志瀚, 苏士成^*

中山大学孙逸仙纪念医院乳腺肿瘤中心,广州510120

通讯作者: *苏士成,Email：sushch@mail.sysu.edu.cn
作者简介:苏士成:研究员、副主任医师、博士生导师。||任中山大学孙逸仙纪念医院乳腺癌研究中心主任、生物治疗中心主任、中山医学院免疫系主任。兼任中国抗癌协会青年理事会常务理事、中国抗癌协会肿瘤免疫代谢学组副组长、中国抗癌协会肿瘤转移专业委员会常务委员、欧洲免疫治疗协会会员。||主要特长为乳腺癌精准外科治疗和免疫治疗的结合。就免疫治疗研究取得有国际影响力原创成果,近5年以通讯作者在Cell（2篇）、Nature、Nature Immunology （2篇）、Nature Cell Biology （2篇）、Nature Cancer （2篇）等期刊发表。主持国自然杰青、重大计划重点项目、集成项目,国家重点研发计划等项目。获得“谈家桢生命科学创新奖”、“求是杰出青年学者奖”、“钟南山青年科技创新奖”、“中国细胞生物学青年科学家奖”等奖项。改良保乳保腋窝的乳腺癌精准手术,获“全国十大医学创新专家”、“广州市实力中青年医生”等称号。推动外科学和免疫学的融合式教学改革,获得教育部“长江青年学者（普外科）”、“霍英东教育基金会高等院校青年教师奖”、指导学生获得“第五届全国大学生基础医学设计大赛一等奖”（唯一指导老师）。
基金资助:
国家自然科学基金杰出青年基金项目（82125017）; 科技部国家重点研发计划项目青年专项（2017YFA0106300）; 国家自然科学基金重大研究计划重点支持项目（92057210）; 国家自然科学基金重大研究计划集成项目（91942309）; 广州市科学技术局重点研发计划（202103000070）

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

OU Xin-yu, LU Yi-wen, LIU Zhi-han, SU Shi-cheng

Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China

Received:2022-02-10 Online:2022-03-17 Published:2022-03-17
Contact: SU Shi-cheng, sushch@mail.sysu.edu.cn

摘要/Abstract

摘要： 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。

关键词: 术中导航, 乳腺癌, 腔镜, 保乳手术

Abstract: Background A growing number of Chinese breast cancer patients are diagnosed at a 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. Patient A 46-year-old woman was diagnosed with left breast cancer with the stage of cT2N1M0 IIB. She asked the surgeons to maintain the breast appearance to the greatest extent. Methods Breast 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 “3D Fusion” function. Finally, we used the probe to precisely mark the tumor border and excised the lump. Results The 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. Discussion Intra-operative navigation system-assisted endoscopic breast-conserving surgery achieves an easier operative procedure and a lower positive rate of surgical margin, which may vigorously promote the endoscopic BCS.

Key words: Intra-operative navigation, Breast cancer, Endoscopy, Breast conserving surgery

中图分类号:

欧欣瑜, 陆艺文, 刘志瀚, 苏士成. 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[J]. 岭南现代临床外科, 2022, 22(01): 1-5.

OU Xin-yu, LU Yi-wen, LIU Zhi-han, SU Shi-cheng. Application of intra-operative navigation in endoscopic breast conserving surgery：a case report[J]. Lingnan Modern Clinics In Surgery, 2022, 22(01): 1-5.

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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

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