肿胀液溶脂法直视下乳腺癌腋窝淋巴结清扫术的临床效果分析  

Direct-vision Breast Cancer Axillary Lymph Node Dissection by Swelling Liquid Fat Dissolving Method:A Clinical Contrast Study

作　　者：盛宇伟[1] 任建强[2] 于金玲[1] 周予民[1] 潘炯[1] 

机构地区：[1]上海交通大学附属上海市第一人民医院宝山分院乳腺外科,上海市200940 [2]上海交通大学附属上海市第一人民医院外科

出　　处：《中国全科医学》2014年第5期594-596,共3页Chinese General Practice

摘　　要：目的探讨肿胀液溶脂法直视下乳腺癌腋窝淋巴结清扫术的临床效果。方法选择2009年12月—2011年9月在上海市第一人民医院宝山分院乳腺外科住院的乳腺癌患者60例,均为女性,按手术方式分为溶脂组30例和传统组30例,分别行肿胀液溶脂法直视下腋窝淋巴结清扫及传统手术,记录术中情况、淋巴结转移率、术后并发症、创面冲洗液脱落细胞学镜检及随访结果。结果两组患者术中情况比较,溶脂组患者的腋窝淋巴结清扫时间较传统组短〔(25.1±2.2)min和(35.2±6.1)min〕,术中出血量较传统组少〔(76.4±26.4)ml和(140.2±56.4)ml〕,差异有统计学意义(t值分别为2.410、7.175,P<0.05)。溶脂组和传统组患者的淋巴结转移率(42/696,47/720)间差异无统计学意义(χ2=0.129,P=0.720)。溶脂组患者术后前臂内侧麻木疼痛发生率少于传统组(6/30和18/30),差异有统计学意义(χ2=10.000,P<0.05)。创面冲洗液脱落细胞学镜检溶脂组未发现阳性病例、传统组发现1例,差异无统计学意义(χ2=1.017,P=0.313)。经1年随访,两组患者均未发现局部复发、切口种植和远处转移。结论肿胀液溶脂法可以清晰暴露乳腺癌患者腋窝血管、神经和淋巴结,直视下行腋窝淋巴结清扫术简单易行,对于保护肋间臂神经、减少术后并发症有重要意义。Objective To evaluate the feasibility and safety of direct - vision breast cancer axillary lymph node dissec- tion （ALND） by swelling liquid fat dissolving method. Methods Sixty female breast cancer patients hospitalized in this hospi- tal from December ：~009 to September 2011 were divided, according to surgical procedures, into groups fat dissolving （FD group, given axillary lymph node dissection by swelling liquid fat dissolving method）, control （given traditional surgical）, 30 in each. Intraoperative state, lymph node dissection and pathological changes, postoperative complications, wound irrigation fluid cytological examination and follow - up results were recorded. Results The time of dissection was shorter in FD group [ （25.1 -＋2.2） mini than in control group [ （35.2 ---6. 1） mini, and the transoperative bleeding less [ （76. 4 ＋26. 4） ml, （140. 2 -＋56.4） ml, respectively~, the difference was significant （t = 2. 410, 7. 175, P 〈 O. 05 ）. There was no significant different in lymph node metastasis between two groups （42/696, 47/720, ~z = 0. 129, P = 0. 720）. The incidence of inner forearm numbness and pain fewer in FD group than in control group （6/30, 18/30）, the difference was significant （~z = 10. 000, P 〈 0. 05）. Wound irrigation fluid cytological examination found that 0 case was positive in FD group, 1 case was posi- tive in control group. The difference was not significant （ X2 = 1. 017, P = 0. 313 ）. After 1 - year follow - up, no one was found to have local recurrence, incision implantation, distant metastasis. Conclusion Swelling liquid fat dissolving method can clearly reveal the axillary vessels, nerves and lymph nodes. Direct - vision axillary lymph node dissection, simple and practica- ble, is of significance to protection of intercostobrachial nerve and reduction of postoperative complications.

关 键 词：乳腺肿瘤 淋巴结切除术 肿胀液溶脂法 

分 类 号：R737.9[医药卫生—肿瘤]