腋窝淋巴结功能分区清扫术降低淋巴结阳性乳腺癌患者术后上肢淋巴水肿的前瞻性随机对照研究  

Functional axillary dissection based on lymphatic drainage for breast cancer:a single center randomized clinical trial

作　　者：袁芊芊 侯晋轩[1] 周瑞[1] 邹声泉[2] 吴高松 Yuan Qianqian;Hou Jinxuan;Zhou Rui;Zou Shengquan;Wu Gaosong(Department of Thyroid and Breast Surgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;Department of General Surgery,Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]武汉大学中南医院甲状腺乳腺外科,武汉430071 [2]华中科技大学同济医学院附属同济医院普通外科,武汉430030

出　　处：《中华医学杂志》2021年第32期2531-2536,共6页National Medical Journal of China

基　　金：武汉大学中南医院疑难病症诊治能力提升工程(肿瘤学)。

摘　　要：目的评估腋窝淋巴结功能分区清扫减少乳腺癌相关上肢淋巴水肿的有效性与安全性。方法前瞻性纳入2018年7月至2019年2月在武汉大学中南医院拟行手术的临床评估淋巴结阳性或前哨淋巴结阳性的女性乳腺癌患者168例。利用计算机产生的随机数表分为腋窝淋巴结功能分区清扫组(试验组)和标准腋窝淋巴结清扫组(对照组)。所有试验组患者均用亚甲蓝示踪前哨淋巴结,随后0.1 ml亚甲蓝缓慢注于蓝染的前哨淋巴结进行分级显影以显影输出淋巴管及下一站淋巴结,钝性分离输出淋巴管,完整显露蓝染的乳腺淋巴引流。移除前哨淋巴结,送术中冰冻病理检查;若前哨淋巴结为阳性,移除下一站蓝染乳腺淋巴结,同时行术中冰冻病理检查;若第二站蓝染乳腺淋巴结为阴性,腋窝淋巴结清扫至第二站淋巴结范围。收集所有患者临床及病理资料;采用上臂固定点周径体积测量法、诺曼问卷评分法,评估两组患者上肢淋巴水肿;比较两组患者临床病理特征、水肿率、局部区域转移率的差异。结果试验组年龄为(50.3±8.0)岁,对照组年龄为(51.1±9.0)岁。试验组患者中,88.1%(74/84)成功施行腋窝淋巴结功能分区清扫,分级显影失败患者行标准腋窝淋巴结清扫并移除试验。比较试验组(n=74)与对照组(n=84)患者的年龄、体质指数、组织学类型、手术方式及辅助治疗方法,差异均无统计学意义(P>0.05)。试验组、对照组的手术时间分别为(169±15)、(123±12)min(范围:145~198、103~146 min)(P<0.001);移除淋巴结数量[M(Q1,Q3)]分别为8.3(6,15)、12.9(7,18)枚(P=0.019)。试验组与对照组相比,中位随访时间(分别为24和23个月)内,周径测量法发现的累积水肿率分别为10.8%(8/74)、23.8%(20/84)(P=0.033),诺曼问卷调查发现的累积水肿率分别为12.2%(9/74)、27.4%(23/84)(P=0.018)。两组患者随访时间内均未出现局部区域复发事件。结论对临床淋巴结�Objective To evaluate the effectiveness and safety of functional axillary dissection based on lymphatic drainage(FUND)in decreasing breast cancer-related lymphedema(BCRL)events.Methods A total of 168 eligible patients in Zhongnan Hospital of Wuhan University from July 2018 to February 2019 were randomly assigned to the FUND group or axillary lymph node dissection(ALND)group using random number table generated by SPSS.In the FUND group,methylene blue(MB)was adopted to reveal the sentinel lymph node(SLN)for all patients;0.1 ml MB was injected into the SLNs before resection to reveal the efferent lymphatic channels and subsequent-echelon lymph node.The blue-stained lymphatic channels were mapped by bluntly dissecting along the lymphatic drainage channels from the breast to the axilla.Then,the SLNs were removed and pathologically analyzed by immediate frozen sectioning(FS);if the SLNs were positive,the blue-stained bALNs in breast lymphatic level(BLL)Ⅱ were removed and sent for immediate FS;if the blue-stained ALNs in BLLⅡ were confirmed negative,the tissues in BLLⅡ were removed'en bloc'.Clinicopathologic information for all the patients in the two groups were collected.The fixed-point circumference volume measurement method and the Norman questionnaire scoring method were used to evaluate the arm lymphedema between the two groups.Clinicopathological characteristics,incidences of arm lymphedema,locoregional recurrence,and distant metastasis between the two groups were compared.Results The mean age were(50.3±8.0)in the FUND group and(51.1±9.0)in the ALND group.Seventy-four cases(88.1%)in the FUND group successfully underwent FUND surgery,and patients whose breast lymphatics failed to be stained blue underwent standard ALND.There was no statistically significant difference in terms of age,BMI,histological types,surgical approaches and adjunct therapy between the FUND group(n=74)and ALND group(n=84)(P>0.05).The average operation time of the FUND group and the stand ALND group were(169±15)and(123±12)min respect

关 键 词：乳腺肿瘤 腋窝淋巴结清扫 上肢淋巴水肿 前哨淋巴结 

分 类 号：R737.9[医药卫生—肿瘤]