浅谈乳腺癌手术中腋窝淋巴结的处理  

The surgical management of axillary lymph node disease in breast cancer patients

作　　者：刘岩松[1] 张丽莎[1] 马菲[1] 郭宝良[1] Liu Yansong;Zhang Lisha;Ma Fei;Guo Baoliang(Department of Breast Surgery,the Second Affiliated Hospital of Harbin Medical University,Harbin 150000,China)

机构地区：[1]哈尔滨医科大学附属第二医院乳腺外科,哈尔滨150000

出　　处：《中华外科杂志》2024年第8期731-736,共6页Chinese Journal of Surgery

摘　　要：乳腺癌腋窝淋巴结的精准评估和处理对于区域控制、乳腺癌分期、辅助治疗决策及预后判断至关重要,手术处理方式整体上呈降阶梯趋势。早期临床腋窝淋巴结阴性的乳腺癌,前哨淋巴结活检(SLNB)已取代腋窝淋巴结清扫(ALND)成为腋窝状态评估的标准,如为阴性,患者可免除ALND。SLNB 1~2枚阳性是否可以免除ALND,在我国仍需谨慎抉择,但符合Z0011研究入组标准的患者可以免除ALND。对于初始临床腋窝淋巴结阳性的乳腺癌患者可以通过新辅助治疗实现腋窝降期达到豁免ALND,腋窝并发症发生率明显降低。新辅助治疗后SLNB尚有诸多问题,如患者仍有腋窝淋巴结转移则不能豁免ALND,与免除SLNB相关的探索和验证研究正在进行中。未来临床医师要综合考虑患者、复发风险及辅助治疗策略,拟定个体化的腋窝淋巴结处理方案。The precise assessment and management of the axillary lymph nodes in breast cancer is crucial for regional control,disease staging,selection of adjuvant chemotherapy strategies,and prediction of prognosis,with a general downward trend in surgical management.For early breast cancer with negative axillary lymph node metastases,sentinel lymph node biopsy(SLNB)has replaced axillary lymph node dissection(ALND)as the criterion for axillary status measurement.Patients can be exempted from ALND if they have negative SLNB results.However,it remains to be carefully decided in China whether patients with one or two positive nodes in SLNB can be spared from ALND.However,consensus has been met that patients who meet the criteria of the Z0011 study can be exempted from ALND.For breast cancer patients with positive axillary lymph nodes metastases at the beginning of treatment,the clearance of lymph node disease can be achieved by neoadjuvant therapy,with a reduced rate of complications related to ALND.In particular,there are still many debates associated with SLNB after neoadjuvant therapy,such as whether patients who remain axillary lymph node positive can be spared from ALND.Exploratory and validation studies related to the SLNB avoidance criteria are still controversial.In the future,clinicians should consider the characteristics of patients,the risk of recurrence,and adjuvant treatment regimens to develop individualized axillary lymph node management.

关 键 词：乳腺肿瘤 前哨淋巴结活组织检查 腋窝淋巴结 新辅助治疗 

分 类 号：R737.9[医药卫生—肿瘤]