32例腔镜下乳腺癌腋窝淋巴结清扫术临床分析

Clinical analysis of 32 cases of breast cancer undergoing endoscopic clearance of axillary lymph nodes

目的探讨腔镜下乳腺癌腋窝淋巴结清扫手术方法、可行性及临床效果。方法回顾性分析32例乳腺癌腔镜下腋窝淋巴结清扫手术（腔镜组）的临床资料，并与46例同期临床分期类似而行传统腋窝淋巴结清扫（传统组）资料比较。结果两组均为Ⅰ～Ⅱ期乳腺癌。腔镜组无中转开放手术，未发生大出血、皮下气肿、脂肪栓塞等并发症。腔镜组淋巴结数目（15．5枚）、平均手术时间（80min）与传统组比较差异均无统计学意义。但缩短了引流时间（3～5d）、减少了出血量（380ml）和术后并发症发生率（仅1例）。结论在选择性乳腺癌患者行腔镜下腋窝淋巴结清扫术能够达到传统腋窝淋巴清扫治疗效果，可在保证腋窝淋巴结清扫质量的同时降低手术并发症发生率，达到了生理、心理的微创化，提高了患者的生活质量。腔镜下腋窝淋巴结清扫术是可行的。

Objective To investigate the operation technique, feasibility and clinical outcome of endo- scopic clearance of axillary lymph node with liposuction（E-ALNC） in 32 patients with breast cancer. Methods From January 2005 to December 2008, a total of 32 patients with breast cancer were treated with E-ALNC. The clinical data of the patients were analyzed retrospectively and compared with those of 46 patients who have underg- one traditional axillary lymph node clearance（T-ALNC）during the same period. Results Both groups were Ⅰ -Ⅱ breast cancer. There were no interim open surgery, massive bleeding, subcutaneous emphysema,fat embolism and other complications in E-ALNC. There was no significant difference between E-ALNC and T-ALNC in lymph number removed（15.5 in E-ALNC） and operation time （80 rain in E-ALNC）. But there was less bleeding （380ml） and lower postoperation complication rate in E-ALNC. Conclusions The E-ALNC and T-ALNC can have the same effect in the breast conserving surgery. The method makes patients attain a physiological and psychological minimal invasiveness. Besides assuring the quality of axillary lymph node clearance, the method can reduce the occurrence of surgical complication and improve the patients＇life quality. E-ALNC can replace the routine surgery and can be carried out in the qualified hospitals.