乳癌に対する内視鏡補助下乳腺全切除と生理食塩水バッグを用いた同時再建術

Endoscope-assisted Subcutaneous Total Glandectomy and Reconstruction using a Saline-filled Prosthesis for Breast Cancer

　教室では，皮膚や筋膜への浸潤所見がない乳癌に対して，中腋窩線切開からのアプローチにより，皮膚を温存した乳腺全切除と生理食塩水バッグを用いた同時再建術を行ってきた．さらなる整容性の向上を目指して，希望した5例に対しこの術式を内視鏡補助下に行ったところ，手術時間は平均約5時間と直視下手術より長いが，腋窩郭清は従来通り直視下に安全に行えて同等の根治性が得られるうえに，腋窩の創痕を著明に縮小することができた．このように，本術式は今後症例を重ねることによって，learning curveが確立すれば，さらに高い整容性が望める有用な術式になりうると考えられた．

Operative procedures and clinical results of an endoscope assisted subcutaneous total glandectomy and recon-struction (STGR) with a saline-filled prosthesis, as a new option for early breast cancer, was described. Five clinical experience is too small to establish a learning curve on this technique at present. however, significant cosmesis with shorter incision is highly evaluated by all patients who received the operation. Furthermore. no postoperative complication was observed, and technical skill is expected to increase after more experience in the future.