Endoscopic neck surgery by the axillary approach
Endoscopic neck surgery by the axillary approach
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DOI：
10.1016/s1072-7515(00)00342-2
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发表时间：
2000-09-01
影响因子：
5.2
通讯作者：
Niimi, M
中科院分区：
文献类型：
--
作者：
Ikeda, Y;Takami, H;Niimi, M
方法患者取仰卧位，颈部微伸，全身麻醉。肿瘤一侧的手臂沿锁骨线向上抬起，露出腋窝。在腋下做一个30毫米的皮肤切口，通过胸大肌的上层提取阔阔肌的下层，首先用手，然后用静脉采集（Johnson-Johnson Medical, Cincinnati， OH）。通过切口插入一个12毫米的套管针，并放置一个钱包线缝合线，以防止气体泄漏和套管针从伤口滑出。然后向体内注入二氧化碳至4毫米汞柱，并通过套管针插入一个灵活的腹腔镜。然后，在内镜引导下，在30毫米皮肤切口下方插入另外两个5毫米套管针（图1）。内镜下使用剪刀进行钝的和尖锐的解剖以扩大前胸和阔下间隙。胸锁乳突肌的前缘与胸舌骨肌分离，后者的一小部分露出胸甲肌。
METHODSThe patient is placed in the supine position, with the neck slightly extended, under general anesthesia. The arm on the tumor side is lifted up, exposing the axilla, along the clavicular line. A 30-mm skin incision is made in the axilla, and the lower layer of the platysma is extracted through the upper layer of the pectoralis major muscle, manually at first, and then with a Vein Harvest (Johnson-Johnson Medical, Cincinnati, OH). A 12-mm trocar is inserted through this incision and a purse-string suture is placed to prevent both gas leakage and trocar slippage out of the wound. Carbon dioxide is then insufflated up to 4-mmHg and a flexible laparoscope is inserted through the trocar. Then, two additional 5-mm trocars are inserted inferior to the 30-mm skin incision under endoscopic guidance (Fig. 1). Endoscopic scissors are used for additional blunt and sharp dissection to enlarge the space in the anterior chest and the subplatysmal space. The anterior border of the sternocleidomastoid muscle is separated from the sternohyoid muscle, and a small part of the latter is served to expose the sternothyroid muscle.