腔镜与开放性手术切除乳腺癌内乳淋巴链的对比研究

A pilot clinical study comparing endoscopic surgery with open surgurey in internal mammary lymph chain of breast cancer

目的对比乳腺癌改良根治术+腔镜下内乳淋巴链切除术与乳腺癌扩大或改良扩大根治术的临床疗效,探讨更适合于乳腺癌内乳淋巴结转移高风险患者的术式。方法取2004年6月至2010年11月在本科住院确诊为乳腺癌且内乳淋巴结转移高风险的患者共97例,其中50例行乳腺癌改良根治+腔镜下内乳淋巴链切除术(腔镜组),47例实施乳腺癌扩大或改良扩大根治术(开放组)。记录两种术式的手术时间、术中出血量、清除的内乳淋巴结数目、术后引流时间、术后恢复时间、术后VAS疼痛评分、术后并发症等指标并进行比较。定量资料比较采用t检验或Mann-WhitneyU检验,定性资料比较采用χ2检验。结果入组97例患者均顺利完成手术,无器官损伤及术后出血等严重并发症。腔镜组术后72hVAS疼痛评分比开放组低(Z=2.26,P=0.02)。两组手术时间、术中出血量、清除内乳淋巴结数目、术后引流时间、术后恢复时间、术后24h疼痛评分及并发症等指标比较,差异均无统计学意义(P>0.05)。术后随访6～15个月,中位随访12个月,入组患者均无复发、远处转移或死亡。结论乳腺癌改良根治术后经腔镜下行内乳淋巴链切除术安全可行、创伤小,疗效不劣于开放手术。

Objective To compare the clinical efficacy between modified radical mastectomy plus endoscopic resection of internal mammary lymph chain and extended or modified radical mastectomy in order to find more suitable surgery for breast cancer patients with high risk of internal mammary lymph node metastasis. Methods Ninety-seven breast cancer patients with high risk of internal mammary lymph node metastases were collected in the Breast Disease Center of Southwest Hospital from June 2004 to November 2010. Among them,50 patients underwent modified radical mastectomy plus endoscopic resection of internal mammary lymph chain （ the endoscopic surgery group ）, and 47 patients underwent extended or modified radical mastectomy （ the open surgery group）. The operative duration , the volume of intraoperative blood loss, the number of internal mammary lymph nodes resected, postoperative drainage time, postoperative recovery time, postoperative pain score and postoperative complications were recorded and compared between the two groups. Statistical analysis was performed using t test or Mann-Whitney U test for quantitative data and chi square test for qualitative data. Results Operations were completed successfully in all the 97 patients, and no organ damage, postoperative bleeding or other serious complications were found. The 72 hour pain scores after surgery in the endoscopic surgery group were lower than in the open surgery group （ Z = 2.26, P= 0.02 ）. There were no statistically significant differences in the average operation duration, the mean blood loss, the average nunrber of internal mammary lymph nodes resected, postoperative drainage time, postoperative recovery time, postoperative 24-hour pain score and complications between the two groups （ P 〉 0.05 ）. The follow-up of 6 - 15 months （ mean 12 months） showed no recurrence, distant metastasis or death in both groups. Conclusion Endoscopic resection of internal mammary lymph chain after modified radical mastectomy is safe and feasible, with less invasion and similar therapeutic effect with the open surgery.