乳腺癌改良根治术中部分腋窝淋巴结清扫的远期疗效分析

Long-Term Effects of Partial Axillary Dissection in Modified Radical Mastectomy of Breast Cancer

目的探讨乳腺癌改良根治术中部分腋窝淋巴结清扫对乳腺癌患者预后及上肢功能的影响。方法选择98例I、Ⅱ期乳腺癌，随机分为部分淋巴结清扫（PALD）组（n=48）和全腋窝淋巴结清扫（TALD）组（=50）。PALD组行乳腺癌改良根治术加部分腋窝Ⅰ、Ⅱ站淋巴结清扫术，TALD组行乳腺癌改良根治术加全腋窝Ⅰ、Ⅱ、Ⅲ站淋巴结清扫术。比较术后远期复发及上肢功能状况。结果随访5～10年，平均4．5年。PALD组胸部局部复发2例（4．2％），腋窝淋巴结复发转移1例（2．1％），锁骨上淋巴结转移1例（2．1％）；TALD组胸部局部复发2例（4．0％），无腋窝淋巴结复发转移，锁骨上淋巴结转移1例（2．0％）；2组差异无统计学意义（P〉0．05）。PALD组发生患肢水肿及功能障碍2例（4．2％），TALD组8例（16．0％），差异有统计学意义（P〈0．01）。PALD组和TALD组患者5年生存率（89．6％比88．0％）及10年生存率（79．2％比78．0％）差异均无统计学意义（P〉0．05）。结论Ⅰ、Ⅱ期乳腺癌实施PALD可减少术后患侧上肢的功能障碍，且不增加预后风险。

Objective To study the effects of partial axillary lymph node dissection （UALD） on prognosis and upper limb function in patients with breast cancer. Methods Ninety-eight breast cancer patients with stage Ⅰ and Ⅱ were randomly divided into two groups and different surgical procedures following modified mastectomy were performed： partial axillary lymph node （level Ⅰand Ⅱ） dissection （PALD） group （n=48） and total axillary lymph node （level Ⅰ, Ⅱand Ⅲ） dissection （TALD） group （n=50）. The long-term positive relapse rate and upper limb function between 2 groups were compared. Results During the follow-up of 5 to 10 years （average 4.5 years）, there were 2 cases （4.2%） of local recurrence on chest wall and one case （2.1%） of recurrence in axillary lymph node and one case （2.1% ） of recurrence in supraclavieular lymph node in PALD group, and 2 cases （4.0%） of local recurrence on chest wall and no axillary lymph node recurrence and one case （2.0%） of recurrence in supraclavicular lymph node happened in TALD group. There was no statistical difference between PALD group and TALD group （P〉0. 05）. The incidence of upper limb edema and dysfunction was 4.2% （2/48） in PALD group and 16. 0% （8/50） in TALD group （P〈0.01）. There was no significant statistical difference of 5-year and 10-year survival rate between PALD group and TALD group （89.6% vs. 88.0%, 79.2% vs. 78.0% ,P〉0.05）. Conclusion PALD may reduce upper limb dysfunction after operation in patients with stage Ⅰ and Ⅱbreast cancer, and does not increase prognostic risk.