早期乳腺癌肋间臂神经以下淋巴结清扫的可行性

Feasibility of lymph node dissection below intercostobrachial nerves in early stage of breast cancer

目的探讨能准确评价腋窝淋巴结是否转移、又减少上肢淋巴肿等并发症的腋窝淋巴结清扫方法。方法 58例早期乳腺癌根据术前腋窝有无肿大淋巴结分为腋窝阳性组33人和腋窝阴性组25人。在腋窝清扫中以肋间臂神经为界,将腋窝淋巴结分为肋间臂神经以上和以下淋巴结。在肋间臂神经以下淋巴结中,根据亚甲蓝染色区分为前哨和非前哨淋巴结。观察腋窝淋巴结转移的特点。结果肋间臂神经以下淋巴结的平均数显著多于前哨淋巴结的平均数(9.17±3.36 vs 2.48±1.14,P<0.01);在两组中,肋间臂神经以下淋巴结的平均数也都显著多于前哨淋巴结平均数(9.32±3.51 vs 2.57±1.14,P<0.01;9.03±2.60 vs 2.40±1.16,P<0.01)。腋窝阳性组的淋巴结转移率显著高于腋窝阴性组(39.39%vs 12.00%,P<0.01)。肋间臂神经以下淋巴结和前哨淋巴结的敏感性、假阴性率和准确率分别是93.75%、6.25%、98.28%和62.5%、37.5%、89.66%。结论肋间臂神经以下淋巴结清扫对于无明确腋窝转移的早期乳腺癌是一种合理的、可供选择的术式。

【Objective】 To explore an axillary lymph node dissection method for an accurate assessment of axillary lymph node metastasis and to decrease the complications such as lymphedema in upper limb.【Methods】 58 cases of patients with early breast cancer were divided into axillary-positive group（33） and axillary-negative group（25） according to the preoperative examination whether there were axillary lymph nodes enlargement.Axillary lymph nodes were divided into the upper lymph nodes that located on top of intercostobrachial nerve and the lower lymph nodes located under the intercostobrachial nerve.Sentinel lymph nodes and non-sentinel lymph nodes were differentiated in those lower lymph nodes by means of methylene blue staining.The metastatic characteristics in such groups of lymph nodes were observed.【Results】 The average number of the lower lymph nodes under the intercostobrachial nerve was bigger than that of sentinel lymph nodes（9.32±3.51 vs.2.57±1.14,P 0.01;9.03±2.60 vs.2.40±1.16,P 0.01）.The similar results were also obtained in axillary-positive group and axillary-negative group（9.32±3.51 vs.2.57±1.14,P 0.01;9.03±2.60 vs.2.40±1.16,P 0.01）.The ratio of metastatic lymph nodes in axillary-positive group was much more higher than that in axillary-negative group（39.39% vs.12.00%,P 0.01）.The sensitivity,false-negative rate and accuracy rate in the lower lymph nodes located under the intercostobrachial nerve and in the sentinel lymph nodes were 93.75%、6.25%、98.28% and 62.5%、37.5%、89.66% respectively.【Conclusions】 The dissection of axillary lower lymph nodes under the intercostobrachial nerve is a reasonable and selectable operation in early stage of breast cancer without clear axillary lymph node metastasis.