简化腋窝淋巴结清扫术在早期乳腺癌治疗中的应用  

The application of simplified axillary lymph nodes dissection on the treatment of early breast cancer

作　　者：黄炜[1] 王亚兵[1] 殷照才[1] 刘三保[1] 陈洁[1] 陈晓林[1] 

机构地区：[1]皖南医学院弋矶山医院甲乳外科,安徽芜湖241001

出　　处：《中国肿瘤外科杂志》2015年第2期83-85,共3页Chinese Journal of Surgical Oncology

摘　　要：目的探讨简化腋窝淋巴结清扫术（axillary lymph node dissection,ALND）在乳腺癌手术中的应用及效果。方法分析2009年1月至2013年6月间行前哨淋巴结活检（sentinel lymph node biopsy,SLNB）327例乳腺癌患者的临床资料,行亚甲蓝染色法SLNB后根据前哨淋巴结（sentinel lymph node,SLN）冰冻病理结果,对SLN阳性者行规范的ALND,SLN阴性则行简化的ALND（只清扫LevelⅠ）,比较两组在手术时间、术后住院时间、腋窝引流时间及术后并发症的差异。结果 327例患者中,314例成功进行了SLNB,119例SLN阳性者行标准的ALND,195例SLN阴性者行简化的ALND,11例SLN阴性患者出现LevelⅠ组织淋巴结转移;简化组手术时间、术后住院时间、腋窝引流时间明显缩短,术后腋窝积液、肌力减退、活动受限、疼痛、麻木、肿胀等并发症明显减少。术后随访3-60个月,患者无腋窝淋巴结复发及远处转移。结论蓝染法SLNB是乳腺癌患者腋窝淋巴结转移状态的重要检测技术,对SLN阴性行简化的ALND,可节省医疗资源、减少术后并发症。Objective To explore the application and effect of simplified axillary lymph node dissection （ ALND） in the operation of breast cancer . Methods Through the analysis of 327 cases of breast cancer patients with clinical data in our department from Jan. 2009 to Jun. 2013 receiving sentinel lymph node biopsy （SLNB）, according to the sentinel lymph node （SLN） frozen pathological results which were used methylene blue staining of SLNB , the patients who were SLN positive did the standard ALND, and the SLN negative patients did the simplified ALND （ only clean up Level I） , Differences on operative time, postoperative hospitalization time, axillary drainage time and postoperative complications were compared between the two groups. Results Among 327 cases, 314 cases successfully carried out SLNB, ALND in 119 cases with SLN positive and 195 cases of ALND negative SLN for simplified ALND. Above all, there were 11 SLN negative cases with the metastasis in Level I tissue lymph node. Compared to the standard ALND, the simplified ALND （ only clean up Level I） has shortened the operative time, postoperative hospitalization time, axillary drainage time obviously, and the armpit dropsy, decreased muscle strength, activity limitation, pain, numbness, swelling and other post-operative complications were reduced significantly. Patients were followed up 3 to 60 months after operation;none of patients were found axillary lymph node recurrence and distant metastasis. Conclusion Methylene blue staining of SLNB is an important detecting technique of valuing the metastasis of the axillary lymph node. Using simplified ALND on breast cancer patients who are SLN negative will save medical resources and reduce the postoperative complications.

关 键 词：乳腺癌 前哨淋巴结活检 腋窝淋巴结清扫 

分 类 号：R737.9[医药卫生—肿瘤]