染料法腋窝反向淋巴作图300例临床研究

Axillary reverse mapping by dye method in 300 breast cancer patients

目的：研究腋窝反向淋巴作图（axillary reverse mapping，ARM）对上肢淋巴回流管网的辨别和保护作用及对减少腋窝淋巴结清扫术后上肢水肿的作用。方法：选取2009年6月至2011年5月蚌埠医学院第一附属医院肿瘤外三科300例单侧乳腺癌患者，在进行腋窝淋巴结清扫前，经上臂内侧肌间沟皮下注射亚甲蓝2～3mL，对上肢来源的淋巴管和淋巴结进行染色，术中加以辨别和保护。术后2个月测量双上臂周径差异（患侧臂周径一健侧臂周径≥2cm为淋巴水肿），记录淋巴水肿的发生情况。结果：300例患者中有195例作图成功，成功率65％。分别于术后6、12、18、24个月进行随访，发现和同期作图失败患者相比较，作图成功患者淋巴水肿的发生率明显降低，差异具有显著性统计学意义。结论：通过腋窝反向淋巴作图（ARM）可以辨别保护上肢回流的淋巴管道，对预防乳腺癌腋窝淋巴结清扫术后上肢水肿具有临床意义。

Objective： To assess the ability of axillary reverse mapping （ARM） to identify and preserve the arm lymphatics drainage as well as determine its ability to reduce lymphedema. Methods： A total of 300 breast cancer patients who underwent axillary lymph node dissection （ALND） from June 2009 to May 2011 were enrolled in this study. Methylene blue dye （2 mL to 3 mL） was injected into the ipsilateral upper inner arm along the medial intramuscular groove to map the upper extremity lymphatic drainage system prior to ALND. The blue lymphatic and lymph nodes were identified and preserved during the operation. The change in the arm circumference was the selected method of measurement. The difference in the bilateral upper arm circumference was recorded after 2 months （difference ≥ 2 cm is defined as lymphedema）. Results： The ARM was performed successfully in 195 （65%） of 300 patients. The incidence of lymphedema was significantly lower in the successfully mapped patients than in the failing mapping patients, with statistically significant difference during follow-up at 6, 12, 18, and 24 months post operation. Conclusion： The ARM technique can identify and preserve the arm lymphatics drainage and prevent upper extremity lymphedema after breast cancer axillary lymphadenectomy.