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- 作者:黄东航|发布时间:2011-10-22|浏览量:657次
Title of Operation:
Indications for Surgery:
This patient has a diagnosis of right breast cancer. Due to her young age of diagnosis, she has elected to undergo bilateral mastectomies with a right axillary sentinel lymph node biopsy.福建省立医院基本外科黄东航
Preoperative Diagnosis:
Postoperative Diagnosis:
Anesthesia:
General by endotracheal tube.
Specimen (Bacteriological, Pathological or other):
Left total mastectomy with short suture superior and long suture lateral. Right total mastectomy with short suture superior and long suture lateral and right axillary sentinel lymph node.
Prosthetic Device/Implant:
Per plastic surgery.
Surgeons Narrative:
EBL: 150 cubic centimeters.
Drains: Per plastic surgery.
Complications: None.
Findings: The patient had a tumor in the right lower outer quadrant that measured approximately 2 cm in size. The right axillary sentinel lymph node was negative by frozen section; therefore, no additional dissection was performed.
Description of Procedure: The patient was brought to the operating room, placed in supine position on operating room table where general anesthesia was induced. Bilateral breasts and the right arm and axilla were prepped and draped in usual sterile manner. There was an area of increased radioactivity in the right axilla therefore no blue dye was injected. The left breast was approached first. The right breast was approached second. Both mastectomies were done in exactly the same manner. A periareolar incision was made. The superior flap was created to the clavicle, the medial flap to the sternum, the inferior flap below the inframammary crease, and lateral flap platysma dorsi muscle. The breast tissue was then dissected off the pectoralis major muscle excising pectoral major muscle fascia. After excising that on the left, the breast tissue was labeled as left total mastectomy with short suture superior and long suture lateral. On the right, it was also labeled in the same manner and labeled as a right total mastectomy with short suture superior and long suture lateral. On the right as I cleared the lateral border of pectoralis major muscle and I divided the clavipectoral fascia, I used the gamma probe to identify the sentinel node. There were 2 nodes identified in the right axilla as sentinel nodes. Both nodes were excised and labeled as right axillary sentinel lymph node #1 and right axillary sentinel lymph node #2. After removal of those 2 nodes, the background in the axilla was less than 10% of the hottest node therefore no additional dissection was performed. The wounds were irrigated. Hemostasis was ensured using clips and electrocautery and Plastic Surgery was contacted to come and complete the patient"s reconstruction. All needle, instrument, and sponge counts were correct at the conclusion of our portion of the procedure.
CLINICAL STAGE OF TUMOR:
T1 N0 M0 right breast cancer.
Drains: Per plastic surgery.
Complications: None.
Findings: The patient had a tumor in the right lower outer quadrant that measured approximately 2 cm in size. The right axillary sentinel lymph node was negative by frozen section; therefore, no additional dissection was performed.
Description of Procedure: The patient was brought to the operating room, placed in supine position on operating room table where general anesthesia was induced. Bilateral breasts and the right arm and axilla were prepped and draped in usual sterile manner. There was an area of increased radioactivity in the right axilla therefore no blue dye was injected. The left breast was approached first. The right breast was approached second. Both mastectomies were done in exactly the same manner. A periareolar incision was made. The superior flap was created to the clavicle, the medial flap to the sternum, the inferior flap below the inframammary crease, and lateral flap platysma dorsi muscle. The breast tissue was then dissected off the pectoralis major muscle excising pectoral major muscle fascia. After excising that on the left, the breast tissue was labeled as left total mastectomy with short suture superior and long suture lateral. On the right, it was also labeled in the same manner and labeled as a right total mastectomy with short suture superior and long suture lateral. On the right as I cleared the lateral border of pectoralis major muscle and I divided the clavipectoral fascia, I used the gamma probe to identify the sentinel node. There were 2 nodes identified in the right axilla as sentinel nodes. Both nodes were excised and labeled as right axillary sentinel lymph node #1 and right axillary sentinel lymph node #2. After removal of those 2 nodes, the background in the axilla was less than 10% of the hottest node therefore no additional dissection was performed. The wounds were irrigated. Hemostasis was ensured using clips and electrocautery and Plastic Surgery was contacted to come and complete the patient"s reconstruction. All needle, instrument, and sponge counts were correct at the conclusion of our portion of the procedure.
CLINICAL STAGE OF TUMOR:
T1 N0 M0 right breast cancer.
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