经肌间入路行锁骨下淋巴结清扫在局部晚期乳腺癌中的应用  

Application of subclavian lymph node dissection through intermuscular approach in locally advanced breast cancer

作　　者：屈洪波 朱芳 徐喆 武楠 何建怀 王先明[1] Qu Hongbo;Zhu Fang;Xu Zhe;Wu Nan;He Jianhuai;Wang Xianming(Department of Thyroid and Breast Surgery,the South China Hospital of Shenzhen University,Shenzhen,518000,China;Health Management Department,Longhua District People’s Hospital,Shenzhen 518000,China;Department of Breast and Thyroid Surgery,the First People’s Hospital of ChenZhou,Chenzhou Hunan Province 423000,China)

机构地区：[1]深圳大学附属华南医院甲状腺乳腺外科,深圳518000 [2]深圳市龙华区人民医院健,深圳518000 [3]郴州市第一人民医院乳腺甲状腺外科,湖南郴州423000

出　　处：《中华普外科手术学杂志（电子版）》2023年第5期510-513,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：湖南省郴州市科技创新引导专项课题(ZDYF2020032)。

摘　　要：目的:探讨经肌间入路行锁骨下淋巴结清扫在局部晚期乳腺癌治疗中的应用价值。方法:回顾性分析2014年4月至2017年4月期间56例局部晚期乳腺癌患者临床资料,根据术式不同分为肌间入路组和腋窝入路组,每组各28例。采用SPSS 22.0统计软件进行数据分析,手术相关指标等计量资料以(^(-)x±s)表示,采用独立样本t检验;术后近、远期并发症资料采用χ2检验。以P<0.05为差异有统计学意义。结果:两组患者均成功完成锁骨下淋巴结清扫术,肌间入路组在手术时间、手术出血量及引流管留置时间低于腋窝入路组,而淋巴结清扫数目高于腋窝入路组,差异均有统计学意义(P<0.05)。两组中位随访时间6年,肌间入路组和腋窝入路组患肢淋巴水肿发生率分别为7.1%及25.0%,胸大肌萎缩率分别为3.6%及21.4%,局部复发率分别为3.6%及17.9%,远处转移率分别为10.7%及28.6%。肌间入路组患者术后各并发症较腋窝入路组低,差异有统计学意义(P<0.05)。结论:针对局部晚期乳腺癌,经胸大肌肌间入路清扫锁骨下淋巴结,不仅淋巴结清扫更彻底,且较好保存胸大小肌功能,手术可操作性强,明显提高患者生活质量。Objective To investigate the application value of subclavian lymph node dissection via intermuscular approach in locally advanced breast cancer.Methods Clinical data of 56 patients with locally advanced breast cancer from April 2014 to April 2017 were retrospectively analyzed and divided into intermuscular approach group and axillary approach group according to different operation methods,with 28 cases in each group.SPSS 22.0 statistical software was used for analysis.Surgical indicators and other measurement data were expressed as(^(-)x±s)and independent t test was used.The near and long term complications were tested byχ2 test,and P<0.05 was considered statistically significant.Results Subclavicular lymph node dissection was successfully completed in both groups.The operation time,surgical bleeding volume and drainage tube retention time in the intermuscular approach group were lower than those in the axillary approach group,while the number of lymph nodes dissection was higher than that in the axillary approach group,with statistical significance(P<0.05).The median follow-up time of the two groups was 6 years.The incidence of limb lymphedema in the intermuscular approach group and the axillary approach group was 7.1%and 25.0%,the incidence of pectoralis major muscle atrophy was 3.6%and 21.4%,the local recurrence rate was 3.6%and 17.9%,and the distant metastasis rate was 10.7%and 28.6%,respectively.The postoperative complications in the intermuscular approach group were lower than those in the axillary approach group,and the difference was statistically significant(P<0.05).Conclusion For locally advanced breast cancer,subclavian lymph node dissection through the pectoralis major intermuscular approach is not only more thorough lymph node dissection,but also better preservation of pectoralis major and small muscle function,strong operability of surgery,and significantly improve the quality of life of patients.

关 键 词：乳腺肿瘤 肌间入路 腋窝入路 锁骨下淋巴结清扫 

分 类 号：R737.9[医药卫生—肿瘤]