上肢淋巴定位辅助腋窝淋巴清扫术——一种乳腺癌根治术改进方法的可行性研究

Axillary lymph node dissection by upper limb lymphatic mapping： an improved approach of mastectomy

目的初步探讨用蓝色染料上肢淋巴定位辅助腋窝淋巴清扫,预防乳癌术后上肢淋巴水肿的可行性。方法选取2007年7月-2008年4月24例行乳癌根治术患者,用蓝色染料上肢淋巴定位辅助腋窝淋巴清扫。收集术中淋巴引流情况、病理结果、术后上肢臂围等数据。结果24例中,施行改良根治术21例,保乳手术3例,均在腋区成功定位引流上肢淋巴液的淋巴管及淋巴结。最初16例切除的蓝染淋巴结病理均为阴性,术后均发生上肢淋巴水肿,后8例保留蓝染淋巴结的患者均未发生淋巴水肿。结论该方法可有效鉴别上肢来源的淋巴引流并加以保护,从而预防淋巴水肿的发生。

Objective Mapping the lymphatic drainage of the upper limb with blue dye decreases the possibility of lymphedema. Methods This study from July 2007 to April 2008 involved patients undergoing axillary lymph node dissection（ALND）. 5 mL of blue dye intradermally was injected in the ipsilateral upper limb. Data were collected on variations in lymphatic drainage and arm circumference, pathological result. Results Of the 24 patients undergoing surgery for breast cancer, including 21 mastectomies and 3 breast preserving mastectomies, blue stained lymphatic vessels or lymph nodes were identified in the axilla of all patients. In the initial 16 cases, the blue stained lymph nodes removed from the axillary region were negative on pathological examination, and subsequent lymphedema developed in all of them but not happened in the other 8 cases whose blue stained lymphatics and nodes were preserved. Conclusions This approach can be used to identify draining lymphatic vessels of upper limb , thus provide an effective way for prevention of lymphedema.