早期乳腺癌肋间臂神经水平淋巴结清扫的应用分析  

Lymph node dissection under the intercostobrachial nerve level in early breast cancer

作　　者：张扬[1] 李建一[1] 张文海[1] 顾玺[1] 贾实[1] 薛今琦[1] 

机构地区：[1]中国医科大学附属盛京医院乳腺外科,沈阳110004

出　　处：《中华内分泌外科杂志》2016年第2期118-123,共6页Chinese Journal of Endocrine Surgery

基　　金：国家自然科学基金（81528010）

摘　　要：目的探讨早期乳腺癌腋窝手术处理中能有效评估腋窝状态且最低限度减少术后并发症的淋巴结清扫范围。方法回顾2011年1月至2013年12月期间手术治疗的331例早期乳腺癌患者，术前系统评估腋窝状态，术中选择单纯染料法前哨淋巴结活检（sentinel lymph node biopsy，SLNB）及冰冻病理学检测。根据腋窝淋巴结的清扫范围将人组患者分为SLNB组（98例）及肋间臂神经水平淋巴结清扫（intercostobrachial nerve level lymph node dissection，ILND）组（233例），对比观察2组的手术利弊。结果单纯染料法标记的前哨淋巴结（sentinellymphnode，SLN）均位于肋间臂神经水平以下，SLN的平均数（5．64±1．68）个，肋间臂神经水平淋巴结的平均数（13．34±3．61）个。SLNB准确率和假阴性率分别是97．42％和2．58％。中位随访时间27．5个月，2组术后并发症的发生率差异无统计学意义。结论ILND对在术中SLN标记失败或存在1个转移的早期乳腺癌患者是有效且并未增加术后并发症的一种合适的腋窝手术方式。Objective To investigate the extent of axillary lymph node dissection which can not only effectively evaluate the axillary status hut also reduce the complications to the minimum in early stage breast cancer. Methods 331 patients with early breast cancer surgically treated from Jan. 2011 to Dec. 2013 were retrospectively analyzed. Their preoperative axillary state was evaluated. They undertook sentinel lymph node biopsy （SLNB） by pure methylene blue dye method and frozen section examination during surgmy. According to the extent of axillary lymph nodes dissection, patients were divided into SLNB group （98 cases） and intercostobrachial nerve level lymph node dissection （ILND） group （233 cases）. The pros and cons of the operation were compared. Results The sentinel lymph nodes （SLN） labeled by methylene blue were located under the intercostobrachial nerve level. The average number of SLN and intercostobrachial nerve level lymph nodes were 5.64±1.68 and 13.34±3.61 respectively. The detection rate and the false negative rate of SLNB was 97.42% and 2.58% respec- tively. The medium follow-up was 27.5 months. There was no significanl difference in postoperative complications including upper limb paresthesia, swelling or limitation of shoulder activity between the two groups. Conclusion ILND is an effective and suitable surgical method in early breast cancer patients with failed intraoperative SLN labeling or with one SLN metastasis.

关 键 词：乳腺癌 腋窝 肋间臂神经 前哨淋巴结 

分 类 号：R737.9[医药卫生—肿瘤]