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- 作者:黄东航|发布时间:2011-10-22|浏览量:1312次
Johns Hopkins Hospital Operative Report
Name: ****** History: ****** Address: ******
***** MD 20*** Date of Operation: **/**/2011 Phone: (240)***-**** Service: SOE DOB: **/**/196* Race: White Gender: Female Attending Surgeon: ****** Assistant(s): 福建省立医院基本外科黄东航
Document No: **********
Title of Operation:
Name: ****** History: ****** Address: ******
***** MD 20*** Date of Operation: **/**/2011 Phone: (240)***-**** Service: SOE DOB: **/**/196* Race: White Gender: Female Attending Surgeon: ****** Assistant(s): 福建省立医院基本外科黄东航
Document No: **********
Title of Operation:
Right breast wire-localized lumpectomy with right axillary node dissection.
Indications for Surgery:
This patient has a diagnosis of a right breast cancer. She has undergone neoadjuvant chemotherapy and had a very good response. Due to the excellent response, we have elected to perform a wire- localized lumpectomy on the right breast and an axillary node dissection for positive nodes prior to the initiation of the chemotherapy.
Preoperative Diagnosis:
Right breast cancer after neoadjuvant chemotherapy.
Postoperative Diagnosis:
Right breast cancer after neoadjuvant chemotherapy.
Anesthesia:
General by endotracheal tube.
Specimen (Bacteriological, Pathological or other):
Right level I and II axillary node dissection and right breast wire-localized lumpectomy.
Prosthetic Device/Implant:
None.
Surgeons Narrative:
Assistant Surgeon: ***.
EBL: 150 cubic centimeters.
Drains: One 15-French Blake drain in the right axilla.
Complications are none.
Findings: The specimen radiograph indicates that the abnormalities contained within the specimen, there were two wires placed on this patient because of the one localizing the clip and the other localizing an ultrasound abnormality.
The patient was brought to the operating room, placed in supine position on the operating table where general anesthesia was induced. The right breast, arm, and axilla were prepped and draped in the usual sterile manner. The right axilla was approached first. The area was anesthetized with 0.25% Marcaine. A lazy S incision was made in the right axilla, was carried through subcutaneous tissues. Using electrocautery, superior and inferior flaps were created. The lateral border of the pectoralis major muscle was cleared as was the lateral border of the latissimus dorsi muscle. The pectoralis major muscle was retracted medially. This allowed access to the level II nodes. The level II nodes were dissected free inferior to the axillary vein and brought into level I of the axilla, it was then dissected along the chest wall to identify the long thoracic nerve. I then dissected further laterally along the axillary vein to identify the thoracodorsal nerve, artery, and vein. These were identified and preserved throughout their length in the axilla. I then dissected the fat pad off subscapularis muscle between these two nerves and then carried the dissection further laterally towards latissimus dorsi muscle completing the right level I and II axillary node dissection. The wound was irrigated. Hemostasis was ensured using clips and electrocautery. A 15-French Blake drain was placed through a separate stab wound. The deep dermal layer was approximated using 3-0 Vicryl sutures and the skin was closed with running 4-0 subcuticular stitch. I then approached the right breast. The wire entered in the right breast at the 10 o"clock position. There were two wires entering the breast, one localizing the clip and one localizing the area of mammographic abnormality. An incision was made between these two wires, but on the more anterior wire closer to the areola both wires entered at the lateral position on the breast. The area was anesthetized with 0.25% Marcaine prior to making the incision. After making the incision, I created flaps over to the wires and brought the wires into the field. The more anterior wire was relatively superficial so I made this a relatively thin segment. I then began excising a segment of tissue completely surrounding both of these wires. After excising, that tissue was oriented for pathology with short suture superior and long suture lateral. There were no palpable abnormalities within the specimen. It was then sent to specimen radiograph, which indicated that both the abnormality and the clip were included within the specimen. After excising that tissue, the wound was irrigated. Hemostasis was ensured using clips and electrocautery. The breast tissue was reapproximated using interrupted 3-0 Vicryl sutures. The deep dermal layers were approximated using 3-0 Vicryl sutures and the skin was closed with running 4-0 subcuticular stitch. All needle, instruments, and sponge counts were correct at the conclusion of procedure. The patient was then awakened in the operating room and extubated and taken to recovery room in stable condition.
CLINICAL STAGE OF TUMOR:
After treatment, Tx N1 M0 right breast cancer.
EBL: 150 cubic centimeters.
Drains: One 15-French Blake drain in the right axilla.
Complications are none.
Findings: The specimen radiograph indicates that the abnormalities contained within the specimen, there were two wires placed on this patient because of the one localizing the clip and the other localizing an ultrasound abnormality.
The patient was brought to the operating room, placed in supine position on the operating table where general anesthesia was induced. The right breast, arm, and axilla were prepped and draped in the usual sterile manner. The right axilla was approached first. The area was anesthetized with 0.25% Marcaine. A lazy S incision was made in the right axilla, was carried through subcutaneous tissues. Using electrocautery, superior and inferior flaps were created. The lateral border of the pectoralis major muscle was cleared as was the lateral border of the latissimus dorsi muscle. The pectoralis major muscle was retracted medially. This allowed access to the level II nodes. The level II nodes were dissected free inferior to the axillary vein and brought into level I of the axilla, it was then dissected along the chest wall to identify the long thoracic nerve. I then dissected further laterally along the axillary vein to identify the thoracodorsal nerve, artery, and vein. These were identified and preserved throughout their length in the axilla. I then dissected the fat pad off subscapularis muscle between these two nerves and then carried the dissection further laterally towards latissimus dorsi muscle completing the right level I and II axillary node dissection. The wound was irrigated. Hemostasis was ensured using clips and electrocautery. A 15-French Blake drain was placed through a separate stab wound. The deep dermal layer was approximated using 3-0 Vicryl sutures and the skin was closed with running 4-0 subcuticular stitch. I then approached the right breast. The wire entered in the right breast at the 10 o"clock position. There were two wires entering the breast, one localizing the clip and one localizing the area of mammographic abnormality. An incision was made between these two wires, but on the more anterior wire closer to the areola both wires entered at the lateral position on the breast. The area was anesthetized with 0.25% Marcaine prior to making the incision. After making the incision, I created flaps over to the wires and brought the wires into the field. The more anterior wire was relatively superficial so I made this a relatively thin segment. I then began excising a segment of tissue completely surrounding both of these wires. After excising, that tissue was oriented for pathology with short suture superior and long suture lateral. There were no palpable abnormalities within the specimen. It was then sent to specimen radiograph, which indicated that both the abnormality and the clip were included within the specimen. After excising that tissue, the wound was irrigated. Hemostasis was ensured using clips and electrocautery. The breast tissue was reapproximated using interrupted 3-0 Vicryl sutures. The deep dermal layers were approximated using 3-0 Vicryl sutures and the skin was closed with running 4-0 subcuticular stitch. All needle, instruments, and sponge counts were correct at the conclusion of procedure. The patient was then awakened in the operating room and extubated and taken to recovery room in stable condition.
CLINICAL STAGE OF TUMOR:
After treatment, Tx N1 M0 right breast cancer.
CC List:
Referring Physician CC List:
***** ****, MD
**** **** Drive Suite ***
******, MD 20***
Phone: (***) ******
Fax: (***) ******
Email: ******@verizon.net
**** **** Drive Suite ***
******, MD 20***
Phone: (***) ******
Fax: (***) ******
Email: ******@verizon.net
Dictated By:
*** ***, M.D. ******/*******/MEDQ D:10/20/2011 00:31:19 T:10/20/2011 06:09:47
*** ***, M.D. ******/*******/MEDQ D:10/20/2011 00:31:19 T:10/20/2011 06:09:47
Attending Addendum:
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