腔镜下乳腺癌前哨淋巴结活检的可行性及手术效果评价  

Feasibility of Endoscopic Sentinel Lymph Node Biopsy in Breast Cancer and the Evaluation of Surgical Efficacy

作　　者：孙二虎[1] 刘小丰[1] 谢晖[1] 陆澄[1] 

机构地区：[1]南京医科大学附属南京妇幼保健院乳腺病科,江苏南京210000

出　　处：《医学临床研究》2014年第9期1699-1702,共4页Journal of Clinical Research

摘　　要：[目的]探讨腔镜下进行乳腺癌前哨淋巴结活检（SLNB）的可行性及临床效果.[方法]对2012年3月至2013年6月于本院行乳腺癌前哨淋巴结活检的118例患者资料进行分析,其中行普通开放手术68例,行腔镜手术50例,均采用单纯亚甲蓝法或联合放射法进行前哨淋巴结探查.分析术后检出率及各种不良反应,比较两组临床效果.[结果]普通开放组SLN检出率联合法为96.87％,亚甲蓝法为82.45％;腔镜组SLN检出率联合法为96.52％,亚甲蓝法为83.70％,比较两组检出率差异无统计学意义（P=0.956,P=0.967）.术中出血量腔镜组明显低于普通开放组（P=0.01）,但手术时间明显高于普通组（P =0.002）.术后并发症：腔镜组患者术后麻木及感染发生率均明显低于开放组（P=0.036,P=0.023）,术后肩部功能恢复腔镜组明显优于普通组（P=0.001）,腋下积液发生率普通组显著低于腔镜组（P=0.001）.[结论]腔镜下行SLNB在安全可行性上与普通开放手术相当,该技术的应用能在保留乳房的同时并维持了腋窝的美观,且能有效减少因普通开放性手术引起的不良后果,值得临床广泛选择运用.[Objective]To explore the feasibility and clinical efficacy of endoscopic sentinel lymph node biopsy（SLNB） in breast cancer.[Methods] The materials of 118 patients with breast cancer undergoing SLNB in our hospital from March 2012 to Jun.2013 were analyzed.Among them,68 cases underwent open biopsy surgery,while 50 cases underwent biopsy under endoscope.Simple methylene blue method or joint radioactive method was adopted for sentinel lymph node（SLN） probe.The detection rate and adverse reactions after operation were analyzed.Clinical efficacy was compared between two groups.[Results] The detection rate of SLN in open group by joint method and methylene blue method were 96.87％ and 82.45％ respectively,while those in endoscopic group were 96.52％ and 83.70％ respectively,but there was no significant difference in the detection rate between two groups（P =0.956,P =0.967）.Intraoperative blood loss in endoscopic group was obviously lower than that in open group （P =0.001）,but the operation time in endoscopic group was obviously longer than that in open group（P =0.002）.The incidence of numbness and infection in endoscopic group after operation were obviously lower than those in open group（P =0.036,P =0.036）.The recovery of shoulder function in endoscopic group was much better than open group（P =0.001）.The incidence of axillary effusion in open group was significantly lower than that in endoscopic group（P =0.001）.[Conclusion] Endoscopic SLNB can obtain the similar safety and clinical efficacy with traditional open surgery.The application of the technique can not only reserve the breast,but also maintain the beautiful outlook of axillary fossa as well as effectively reduce the adverse outcome caused by traditional open surgery.Therefore,it is worthy of wide clinical application.

关 键 词：内窥镜检查 前哨淋巴结活组织检查/方法 乳腺肿瘤/病理学 乳腺肿瘤/外科学 

分 类 号：R737.9[医药卫生—肿瘤]