乳腔镜腋窝淋巴结清扫术的初期应用分析

Analysis of early stage results from mastoscopic axillary lymphadenectomy for breast cancer

目的:探讨乳腔镜腋窝淋巴结清扫术的疗效,并与传统腋窝淋巴结清扫术的早期结果进行对比。方法:选取2012年1月至2013年4月收治的54例临床Ⅰ、Ⅱ期乳腺癌患者,其中腔镜组12例,传统手术组42例,对比分析两组患者临床资料及手术指标。结果:两组手术均顺利完成。两组患者创面引流液量、引流时间、术后住院时间、淋巴水肿、创面积液及清除淋巴结数量差异无统计学意义(P>0.05),腔镜组在术后患侧上肢疼痛、麻木及肩部活动受限率方面优于传统手术组(P<0.05),尽管腔镜组手术时间稍长于传统手术组(P=0.001),但腔镜组术中出血量明显少于传统手术组(P=0.004)。结论:掌握精细的腔镜操作技术,熟悉腋窝结构,术中细致解剖,手术流程正确,早期开展乳腔镜腋窝淋巴结清扫术是可行的,显著改善了腋窝淋巴结清扫手术的预后,达到了生理微创与心理微创的双重目的,与传统手术相比优势明显。

Objective：To evaluate the efficacy of mastoscopic axillary lymph node dissection （MALND） by comparing the early stage results with conventional axillary lymph node dissection （ CALND ）. Methods： Fifty-four patients with stage Ⅰ or stage Ⅱ breast cancer between Jan. 2012 and Apr. 2013 were included and assigned to 2 groups：MALND （ 12 cases） and CALND （42 cases）. All the patients were followed up for 2 to 17 months. Their clinical and operative data were comparatively analyzed. Results：All operations were successful. MALND group had similar wound drainage volume, drainage time, postoperative hospital stay, lymphedema, effusion at wound and number of harvested lymph node with CALND group （ P 〉 0.05 ）. The postoperative ipsilateral upper limb pain and numbness, ac- tivities of the shoulder in MALND group were better than CALND group （ P 〈0. 05 ）. Although the total operative time was longer in MALND group （P = 0.001 ） ,the blood loss in the operation of MALND group was less than that in the CALND group （P = 0. 004）. Conclusions：Early MALND is feasible on the basis of elaborate endoscopic technique ,familiar axillary structure,intraoperative careful anatomy and correct surgical process, which evidently improves the prognosis of axillary lymph node dissection. Compared with CALND, MALND has obvious advantages, and is mini-invasive in both physiological and psychological aspects.