临床腋淋巴结阳性乳腺癌患者行全腋窝淋巴结清扫的应用探讨

The clinical research of axillary lymph node dissection in breast cancer with apparent clinical axillary lymph node

背景与目的:临床腋淋巴结阳性乳腺癌患者常规行全腋窝淋巴结清扫,本研究探讨改良根治术时采用改进L3组淋巴结清扫方式的临床应用及意义。方法:322例临床腋淋巴结阳性的乳腺癌患者中,154例采用改进的L3组淋巴结清扫方式,168例行常规Auchinclos改良根治术,对两种手术方式所用时间和术后不良反应进行比较,同时随访观察患者的无病生存率。结果:两种手术方式所用手术时间、术后不良反应差异无统计学意义(P>0.05),行改进术式患者腋下淋巴结总数及L3组淋巴结数较常规术式多,两组差异有统计学意义(P<0.05),L3组淋巴结未转移患者5年无病生存率为68.6%,L3组淋巴结转移患者5年无病生存率为35.7%,差异有统计学意义(P<0.05)。结论:对临床腋淋巴结阳性乳腺癌患者行L3组淋巴结清扫具有一定的临床应用价值,采用改进的淋巴结清扫方式,便于L3组淋巴结的清扫。

Background and purpose：Breast cancer patients with clinically apparent axillary lymph nodes were always treated with axillary lymph node dissection,the purpose of this study was to identify the clinic application and significance of modified radical mastectomy about improved ter-group axillary lymph node dissection.Methods：In this study,322 patients with clinically apparent axillary lymph nodes were collected,154 patients were operated by improved ter-group axillary lymph node dissection,168 patients were operated with regular axillary lymph node dissection.Results：The difference of the 2 types of surgery has no statistical significance in operative time and side effect（P〉0.05）,but has statistical significance in axillary lymph nodes and ter-group axillary lymph nodes（P〈0.05）.Five-year disease-free survival of patients with negative ter-group axillary lymph was 68.6%,and for the positive was 35.7%,the difference of the 2 surgical methods has statistical significance（P〈0.05）.Conclusion：There are specified clinically meaning for patients with clinically apparent axillary lymph nodes,they were operated by improved ter-group axillary lymph node dissection,and this will make it easy in dissect ter-group axillary lymph nodes.