吸脂法腔镜腋窝淋巴结清扫手术的技术探讨

Technique investigation of endoscopic axillary lymph node dissection by liposuction

目的探讨吸脂法腔镜腋窝淋巴结清扫的手术技术.方法分析采用吸脂法进行完全腔镜腋窝淋巴结清扫手术的45例患者的临床资料,并与传统开放手术进行比较.结果完全腔镜腋窝淋巴结清扫手术组清扫淋巴结8～34枚,平均18枚;腔镜腋窝淋巴结清扫手术时间为60～190min,平均108 min,较传统手术时间长（P＜0.05）.腔镜手术组出血量为80～220 ml,平均152.82 ml,明显少于常规手术组280.29 ml（P＜0.01）.腔镜手术组术后腋窝引流量为60～180 ml,平均140.38ml,拔引流管时间6～15 d,平均6.91 d.术后皮下积液7例,皮肤表皮水疱5例,胸壁和上臂内侧蜂窝织炎2例.腔镜手术组在清扫腋窝淋巴结数目、术后引流量、引流时间、术后并发症等方面与常规开放性手术相比较无明显差异（P＞0.05）.结论腔镜手术组手术切口相对较小,美容效果较好,患者比较满意.吸脂法腔镜腋窝淋巴结清扫可以达到常规手术的清扫范围,但技术有待进一步规范.

Objective To study the technique of endoscopic axillary lymphy node dissection by liposuction, Methods Endoscopic axillary lymph node dissection （ E-ALND ） after liposuction （ group A） were performed on 45 patients with breast cancer from Des. 2004 to Oct. 2005. It was compared with traditional ALND （group B）, Results The average operation time of E-ALND was 108 min （60-190 min）, it was longer than that in group B（P 〈0.05）. The total blood loss in group A was 152.82 ml （80～220 ml）, it was less than that in group B significantly（P 〈0. 01 ）. In group A, the mean lymph nodes harvested by endoscopy were 18（8～34）, the total postoperative lymph flow was 140, 38 ml（60 ～ 180 ml）, the duration of drainage was 6. 91 d （6 ～ 15 d ）, The postoperation complication included axillary seromas 7 cases, epidermic blister 5 cases, operation area phlegmon 2 cases were found in group A. There was no significant difference between two groups in the total postoperative lymph flow, the duration of drainage and the number of dissected lymph nodes and postoperation complication, The incision of chest wall was smaller in group A, and patients by this surgery were satisfied with the cosmetic results, Conclusions Endoscopic axillary lymph node dissection by liposuction could match the traditional lymphadenectomy. The technique should be further standardized.