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目的研究胸前壁内乳区的局部解剖,探讨经肋间隙入路行内乳淋巴结活检的可行性和安全性。方法113例乳腺癌患者均接受不同术式的根治术及经肋间隙内乳淋巴结活检术。术中测量胸骨外缘距胸廓内动脉的距离和肋间隙的宽度,记录内乳淋巴结的部位和最大直径。结果胸廓内动脉距胸骨外缘的距离在第1、2、3和4肋间隙分别为(10．9±4．5)mm、(11．6±3．O)mm、(9．6±3．6)mm和(4．5±3．5)mmo第1、2、3、4肋间隙宽度分别为(14．2±4．1)mm、(16．2±4．2) mm、(13．9±4．3)mm和(9．9±3．6)mm c 113例乳腺癌共切除内乳淋巴结279枚。内乳淋巴结位于胸廓内动脉周围的脂肪组织中,在血管内侧占41．2％,外侧占51．6％,前方为7．2％。113例乳腺癌患者中内乳淋巴结转移者26例,其中仅有内乳淋巴结转移者5例。结论切开胸骨外缘肋间肌2-3．5 cm所提供的术野能完成内乳淋巴结活检,此方法具有操作简便、创伤小、安全性高的特点。
Objective To study the local anatomy of the internal breast area of the anterior chest wall and explore the feasibility and safety of intramural breast lymph node biopsy through intercostal approach. Methods A total of 113 patients with breast cancer underwent radical resection of the different surgical procedures and intracapillary intramural lymph node biopsy. The distance from the sternal border to the internal thoracic artery and the width of the intercostal space were measured intraoperatively, and the location and maximum diameter of the internal mammary lymph nodes were recorded. Results The distance from the outer sternum of the internal thoracic artery to the outer rim of the sternum was (10.9±4.5) mm, (11.6±3.0) mm, (9.6±) 3.6) mm and (4.5 ± 3.5) mmo The gap width of the first, second, third and fourth ribs is (14.2±4.1) mm and (16.2±4.2) mm, respectively (13.9 ± 4.3) mm and (9.9 ± 3.6) mm c 113 cases of breast cancer were removed 279 internal breast lymph nodes. The internal mammary lymph nodes were located in the adipose tissue around the internal thoracic artery, accounting for 41.2% in the medial vessel, 51.6% in the lateral and 7.2% in the anterior. Of the 113 patients with breast cancer, 26 had internal breast lymph node metastases, of whom only 5 had internal breast lymph node metastases. Conclusions The surgical field provided by cutting the intercostal muscle of the outer rim of the intercostal muscle 2-3.5 cm can complete the internal mammary lymph node biopsy. This method has the characteristics of simple operation, less trauma and high safety.