腔镜在早期乳腺癌腋窝淋巴结清扫中的应用价值：附21例报告

The applied value of endoscopic axillary lymphadenectomy with liposuction in 21 patients with early breast cancer

目的探讨应用腔镜行早期乳腺癌腋窝淋巴结清扫术（E-ALND）的价值。方法收集近2年内采用吸脂法进行腔镜下腋窝淋巴结清扫手术的2l例早期乳腺癌患者的临床资料，并与同期传统手术进行比较。结果21例E-ALND手术中无l例中转开放手术。与传统手术相比，腔镜腋窝淋巴结清扫术清除淋巴结的数量无明显差异[（18．26±4．62）枚VS．（17．15±3，83）枚]；手术时间明显延长[（82．2l±28．12）minVS，（138．42±36．06）min]；腋窝出血量显著减少[（192．16±60．27）mLVS，（1l5，3l±32．18）mL]；拔除腋窝引流管时间明显缩短[（10．1±3．2）dVS．（6．8±2，8）d]。3个月的随访结果显示，与传统手术相比，腔镜组上肢感觉异常发生率明显减少（32．2％VS．4．78％），但上肢疼痛、水肿发生率无明显差异。腔镜组术后出现局部皮肤水疱2例，胸壁蜂窝组织炎1例，皮下积液2例，均治愈。随访2-21个月，未见trocar处种植转移。结论腔镜行早期乳腺癌腋窝淋巴结清扫术具有切口小、隐蔽，术后恢复快，并发症少，且符合美学要求，较传统的腋窝淋巴结清扫术有明显的微创优势，具有较好的应用前景。

Objective To investigate the role of complete endoscopic axillary lymphadenectomy in axillary lymph node dissection （ ALND ） in early breast cancer patients. Methods A total of 21 patients with breast cancer underwent mastectomy and complete endoscopic axillary lymph node dissection （E-ALND） with liposuction in recent 2 years. All available data relating to endoscopic axillary surgery were compared with traditional ALND. Results No E-ALND had to be converted into open procedures. Compared with traditional ALND, there was no obvious difference in the number of lymph nodes removed [ （ 18. 26 ± 4. 62 ） vs. （17. 15 ± 3.83） ] , but the operating time was remarkably longer [ （82.21 ± 28. 12）min vs. （138.42 ± 36.06） min]. the drainage time shorter [（10. 1±3.2） d vs. （6.8±2.8） d], and operative blood loss lower [（192. 16 ±60.27）mL vs. （115.31±32. 18）mL]. After three months follow-up,the occurrence of upper ann numbness in E-ALND group was notably lower than that in traditional ALND group （ 32.2 % vs. 4.78 % ） , but the pain and edema of are were no significant difference between the 2 groups （ P 〉 0.05 ）. In E-ALND group there were epidermic blisters in 2 cases, chest wall cellulitis in 1 case, and axillary seromas in 2 cases after operation. No port-site metastasis occurred during follow-up with a median of 8.9 （ 2 - 21 ） months. Conclusions Endoscopic liposuction can be safely and feasibly applied for complete axillary lymph nodes dissection （ALND） because it is associated with acceptable minimal skin incision, less complications in the upper limb, while offering a better cosmetic result to the patients in comparison with the traditional ALND, and it represents an attractive alternative for ALND.