乳腔镜前哨淋巴结活检及腋窝淋巴结清扫的临床应用分析  

Clinical application of mastoscopic axillary sentinel lymph node biopsy and axillary lymph node dissection for breast cancer

作　　者：张前进[1] 胡伯年[1] 裴俊烽[1] 

机构地区：[1]浙江省绍兴文理学院附属医院肿瘤外科,312000

出　　处：《中华全科医学》2015年第4期574-575,578,共3页Chinese Journal of General Practice

基　　金：浙江省绍兴市科技计划项目(2009A33022)

摘　　要：目的 探讨乳腔镜下前哨淋巴结活检及腋窝淋巴结清扫在乳腺癌患者临床诊疗中的可行性及较常规开放手术的优劣势。方法 随机选取2005年12月—2012年3月肿瘤外科经针吸活检或术中快速冰冻病理诊断为乳腺癌且分期为Ⅰ、Ⅱ期的患者40例,通过术中美兰示踪及术前B超定位在乳腔镜下对40例乳腺癌患者行前哨淋巴结活检术（ESLNB）及腋窝淋巴结清扫术（EALND）,根据蓝染及术前B超定位寻找SLN,乳腔镜下切除SLN并清扫Ⅰ、Ⅱ组淋巴结,如Ⅱ组淋巴结有明显肿大者则一并清扫Ⅲ组淋巴结,对切除淋巴结行HE染色病理分析。结果 两术式每位患者切除淋巴结数目范围为：ESLNB为1-5枚,平均3.1枚;EALND为11-29枚,平均12.8枚。ESLNB检出率为95.0%（38/40）,准确率92.1%（35/38）,假阴性率15.0%（3/20）,灵敏度85.0%（17/20）;SLN多位于胸肌组,其中37例位于胸肌组,1例位于胸肌间组;40例患者均顺利完成乳腔镜,无中转开放手术,术中无重要血管神经损伤;术后无明显并发症,但有3例患者术后发生肢体疼痛、感觉异常。结论 乳腺癌患者乳腔镜下前哨淋巴结活检及腋窝淋巴结清扫术具有较好可行性,美容效果好,并发症低,可对腋窝淋巴结准确分期。Objective To evaluate the feasibility and advantage of mastoseopic axillary sentinel lymph node biopsy and mastoseopie axillary lymph node dissection for breast cancer. Methods Forty patients with stage I or II breast cancer confirmed by aspiration biopsy or frozen pathological diagnosis during Dec. 2005 to Mar. 2012 were enrolled in this study. Guided by intraoperative methylene blue tracer and preoperative B-ultrasound localization, mastoscopie axillary sentinel lymph node biopsy and axillary lymph node dissection were performed in all 40 patients. The sentinel lymph nodes（SLN） were removed ; group 1 and 2 lymph nodes were dissected ; if group 2 lymph nodes enlarged obviously, group 2 lymph nodes were also dissected. All the samples were analyzed by histopathological examination. Results The number of dissected lymph nodes for each patients were 1 to 5 （ mean 3.1 ） by mastoscopic axillary sentinel lymph node biopsy and 11 to 29 （mean 12.8） by mastoscopic axillary lymph node dissection. The SLN detection rate by mastoscopic axillary sentinel lymph node biopsy was 95.0% （ 38/40）, the accuracy rate was 92.1% （ 35/38 ）, false negative rate was 15.0% （ 3/20）, and sensitivity rate was 85.0% （17/20） ;Most of the SLN were located at pectoralis muscles（ 37/40 ）, only one at intra- pectoralis muscles;the endoscopy operation in all of the 40 cases were succeed, no cases converted to open surgery;there was no important blood vessels and nerve injury, postoperative complication ;3 cases were with limbs pain and paraesthesia. Conclusion The mastoscopic axillary sentinel lymph node biopsy and axillary lymph node dissection are technically feasible with a good cosmetic effect and little complication. It can provide accurate lymph node stages.

关 键 词：乳腔镜 前哨淋巴结切检 腋窝淋巴结清扫 乳腺癌 

分 类 号：R737.9[医药卫生—肿瘤] R730.56[医药卫生—临床医学]