前哨淋巴结活检在早期浸润性乳腺癌保乳手术中的应用价值  

Application value of sentinel lymph node biopsy in breast-conserving surgery of early invasive breast cancer

作　　者：单世胜 葛冠群[2] 王华龙 SHAN Shi-Sheng, GE Guan-Qun, WANG Hua-Long(Department of General Surgery, Xianyang Central Hospital, Xianyang, Shaanxi 712000, Chin)

机构地区：[1]咸阳市中心医院普通外科,陕西咸阳712000 [2]西安交通大学第一附属医院肿瘤科,陕西西安710061

出　　处：《中国妇幼保健》2018年第7期1453-1456,共4页Maternal and Child Health Care of China

基　　金：国家自然科学基金(81402200)

摘　　要：目的分析前哨淋巴结活检术(SLNB)对早期浸润性乳腺癌腋窝淋巴结转移的诊断效能及其在保乳手术中的应用价值。方法回顾性分析2012年7月-2015年5月该院收治的217例早期浸润性乳腺癌患者的临床资料,均行SLNB和保乳手术治疗,以术后病理为金标准分析SLNB对腋窝淋巴结转移的诊断效能。同时,根据患者意愿将前哨淋巴结(SLN)阴性者分为两组,清扫腋窝淋巴结者为对照组,未清扫者为观察组,对比其手术情况、术后转归及生存质量。结果 SLNB诊断腋窝淋巴结转移的灵敏度、特异度、漏诊率、误诊率和准确度分别为92.1%、100.0%、7.9%、0、94.4%。观察组手术时间短,术中出血量和术后引流量少,拔管时间早,与对照组相比差异均有统计学意义(均P<0.05)。观察组并发症发生率低于对照组(P<0.05);复发率、转移率及死亡率比较,差异均无统计学意义(均P>0.05)。治疗前,两组患者的欧洲癌症研究与治疗组织生存质量问卷(EORTC QLQ-C30)和欧洲生命质量协作组乳腺癌专用生命质量量表(QLQ-BR23)评分比较,差异均无统计学意义(均P>0.05);治疗后,观察组功能和症状评分低于对照组,总生存质量评分高于对照组,差异均有统计学意义(均P<0.05)。结论SLNB对早期浸润性乳腺癌腋窝淋巴结转移的诊断效能较高,用以指导保乳手术可降低术后并发症,提高患者的生存质量,具有较好的应用价值。Objective To analyze the diagnostic efficiency of sentinel lymph node biopsy （SLNB） for axillary lymph node metastasis in early invasive breast cancer and its application value in breast-conserving surgery. Methods The clinical data of 217 patients with early invasive breast cancer treated in Xianyang Central Hospital from July 2012 to May 2105 was analyzed retrospectively. All the patients underwent SLNB and breast-conserving surgery. The diagnostic efficiency of SLNB for axillary lymph node metastasis was analyzed taking postoperative pathology as gold standard. At the same time, the SLNB-negative patients were divided into two groups according to the patients＇ will： the patients in control group underwent axillary lymph node dissection, while the patients in observation group didn＇t undergo axillary lymph node dissection. The operation situations, postoperative outcome, and quality of life were compared between the two groups. Results The sensitivity, specificity, missed diagnostic rate, misdiagnostic rate, and accurate rate of SLNB for diagnosis of axillary lymph node metastasis were 92. 1% , 100. 0% , 7.9% , 0. 0% , and 94. 4% , respectively. Compared with control group, the operation time in observation group was shorter, the intraoperative bleeding volume and postoperative drainage volume were less, and the drainage tube extubation time was earlier, there were statistically significant differences （P〈0. 05 ） . The incidence rate of complications in observation group was statistically significantly lower than that in control group （P〈0. 05 ） . There was no statistically significant difference in recurrence rate, metastasis rate, and mortality rate between the two groups （P〉0. 05） . Before treatment, there was no statistically significant difference in EORTC QLQ-C30 and QLQ-BR23 scores between the two groups （P〉0. 05） . After treatment, function and symptom scores in observation group were statistically significantly lower than those in control group, while the total score o

关 键 词：前哨淋巴结活检 腋窝淋巴结清扫 早期浸润性乳腺癌 生存质量 

分 类 号：R737.9[医药卫生—肿瘤]