第6巻 2010年6月　第3号

■綜説

乳腺内視鏡手術と3D-CT乳腺リンパ管造影＜その1＞乳腺内視鏡手術の整容性と根治性
山下　浩二
日本医科大学大学院医学研究科機能制御再生外科学

Video-Assisted Breast Surgery and 3-Dimensional Computed Tomographic Mammary Lymphography <1> Aesthetic Results and Curability of Video-assisted Breast Surgery
Koji Yamashita
Department of Biological Regulation and Regenerative Surgery, Graduate School of Medicine, Nippon Medical School

Background: I have studied endoscopic surgery for breast diseases and have studied 3-dimensional computed tomographic lymphography for sentinel node biopsy. In this chapter, I introduced my works of the endoscopic breast surgery. I devised a new endoscopic operation for breast diseases: video-assisted breast surgery. The goal of endoscopic breast surgery is to obtain better cosmetic outcomes.
Methods: A 2.5-cm axillary or periareolar skin incision was made. Under video assistance, the mammary gland was partially or totally resected with a gasless method. A transaxillary retromammary route approach was used even for tumors of the medial aspect of the breast. For malignant tumors, sentinel node biopsy was performed, and axillary nodes were dissected. Breast reconstruction was performed simultaneously.
Cosmetic results: Cosmetic results were assessed with a standard 4-step method and the method described in the Japanese guidelines for breast-conserving therapy. More-objective quantitative methods are breast retraction assessment, the method reported by the research group of Sawai, and ABNSW, a 5-item, 4-step method that evaluates asymmetry (A), breast shape (B), nipple deformation (N), skin condition (S), and wound scar (W). The cosmetic results in endoscopic breast surgery showed that almost 90% of patients received a total score greater than 11 points, which indicates that this video-assisted breast surgery achieves better cosmetic results. The reconstruction methods in breast-conserving therapy are mammary gland translocation, the lateral tissue flap filling method, and absorbable thread mesh filling. The filling methods are superior to the translocation at the point of less deformation of the breast shape. Reconstruction with filling methods will allow wider excision of the mammary gland while achieving better cosmetic results.
Results: Video-assisted breast surgery is less invasive, produces no scars on the breast skin, and achieves better aesthetic outcomes for patients with breast cancer. It also improves quality of life. The long-term results of this surgery in regards to morbidity have proven good after a maximum follow-up period of 8 years.
Conclusions: Video-assisted breast surgery achieves good locoregional control and provides aesthetic advantages. It can be used to treat multiple breast diseases and advanced disease after preoperative systemic treatment.

日医大医会誌 2010; 6(3), 104-110

Key words
breast cancer, endoscopic surgery, sentinel node biopsy, aesthetic results, reconstruction

Correspondence to
Koji Yamashita, Department of Biological Regulation and Regenerative Surgery, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku Tokyo 113-8603, Japan
E-mail：yamasita@nms.ac.jp

受付：2009年11月30日　受理：2010年4月23日