I,II期乳腺癌部分腋窝淋巴结清扫术远期疗效分析

Long term effects of partial axillary dissection in radical mastectomy for patients with stage I and II breast cancer

目的 探讨Ⅰ,Ⅱ期乳腺癌部分腋窝淋巴结清扫术对乳腺癌患者的预后及上肢功能的影响.方法 随机选择临床Ⅰ,Ⅱ期乳腺癌部分腋窝淋巴结清扫组（PAL）及全腋窝淋巴结清扫组（TAL）各110例.PAL组行乳腺癌改良根治术加部分腋窝淋巴结（Ⅰ,Ⅱ组淋巴结）清扫术,TAL组行乳腺癌改良根治术加全腋窝淋巴结清扫术.比较术后远期复发及上肢功能状况.结果 随访5～10年,PAL组胸部局部复发4例,占3.8%（4/106）,腋窝淋巴结复发转移1例;TAL组胸部局部复发5例,占4.9%（5/103）,无腋窝淋巴结复发转移;两组差异无显著性（P＞0.05）.PAL组发生患肢水肿及功能障碍5例,占4.7%（5/106）;TAL组12例,占11.7%（12/103）,差异有极显著性（P＜0.01）.两组5年和10年生存率均无明显统计学差异.结论 Ⅰ,Ⅱ期乳腺癌实施使PAL可减少患肢的术后功能障碍,不增加预后风险.

Objective To study the effect of partial axillary lymph node dissection in patients with stage Ⅰ and Ⅱ breast cancer. Methods One hundred and ten patients with stage Ⅰ and Ⅱ breast cancer were randomly selected to partial axillary lymph node dissection （PLA） and 110 patients to total axillary lymph node dissection （ TAL ） . After modified mastectomy, partial axillary lymph node dissection （ level Ⅰ, Ⅱ lymph nodes ） was performed in PLA group, and total lymph node dissection was performed in TAL group. The long-term positive relapse rate and upper limb function between the 2 groups were compared. Results At 5-10-years follow-up, there were 4 cases （3. 8 % ） of local chest recurrence, and 1 case of recurrence in axillary lymph nodes in PAL group ; and 5 cases （ 4. 9 % ） of local chest recurrence , and no case of recurrence in axillary lymph nodes in TAL group. There was no statistical difference between PAL group and TAL group （ P 〉 0.05 ） . There were 5 cases （ 4.7 % ） of upper limb edema and functional handicap in PAL group, and 12 cases （ 11 . 7 % ） of upper limb edema and functional handicap in TAL group, there was a statistical difference between PAL group and TAL group （ P 〈 0. 01 ） . There was no obvious statistical difference in fiveyear and ten - year survival rates between PAL group and TAL group （ P 〈 0.01 ） . Conclusions Partial axillary lymph node dissection may reduce upper limb functional handicap after operation in patients with stage Ⅰ and Ⅱ breast cancer, and does not increase prognostic risk.