腔镜下腋窝淋巴结清扫与传统手术的对比研究

Comparison of Endoscopic Axillary Lymph Node Dissection and Traditional Surgery

目的探讨腔镜下腋窝淋巴结清扫术的安全性、可行性,并对患者术手上肢功能状况进行评价。方法比较32例乳腺癌腔镜下腋窝淋巴结清扫术(腔镜组)与35例乳腺癌传统腋窝淋巴结清扫术(传统组)的术中出血量、手术时间和淋巴结清扫数目;术后3个月随访上肢情况,比较2组患侧上肢的感觉、运动功能和水肿情况。结果腔镜组术中出血量为(36.25±6.96)mL,显著少于传统组的(68.29±17.45)mL(P<0.01);腔镜组手术时间为(186.41±13.81)min,显著长于传统组的(158.86±16.09)min(P<0.01);2组手术淋巴结清扫数目差异无统计学意义[(16.00±3.47)枚比(16.86±2.94)枚,P>0.05]。术后3个月随访患侧上肢情况,感觉异常、运动受限和上肢水肿发生率腔镜组分别为18.75%、6.25%和9.37%,传统组分别为65.71%、28.57%和28.57%,腔镜组患侧上肢感觉异常、运动受限及上肢水肿者明显少于传统组(P<0.01或P<0.05)。结论腔镜下腋窝淋巴结清扫手术安全、可行,具有微创、美观、上肢功能好等优点。

Objective To investigate the safety and feasibility of endoscopic axillary lymph node dissection,and to evaluate the upper extremity functional status. Methods Intraoperative blood loss,operation time and number of lymph nodes dissected were determined in 32 breast pa- tients who underwent endoscopic axillary lymph node dissection （laparoscopy group） and 35 canc- er patients who underwent traditional axillary lymph node dissection （traditional group）. The up- per extremity functional status was evaluated 3 months after operation. The sensory and motor functions of unilateral upper limb and incidence of edema were compared between the two groups. Results Compared with traditional axillary lymph node dissection, endoscopic axillary lymph node dissection decreased intraoperative blood loss [（36.25 ± 6.96）mL vs （68.29±17.45）mL, P〈0.01],but increased operation time [（186.41±13.81） minutes vs （158.86±16.09） minutes, P〈0.01]. No significant difference in the number of lymph nodes dissected was found between laparoscopy group and traditional group [（16.00±3.47） vs （16.86 ± 2.94）, P〉0.05]. After 3 months of follow-up, the incidences of paresthesia, motion limitation and upper limb edema in lap- aroscopy group （18.75%, 6.25% and 9.37% ,respectively） were significantly lower than those in traditional group （65.71%,28.57% and 28.57%,respectively） （P〈0.01 or P〈O. 05 ）. Conclusion Endoscopic axillary lymph node dissection is a safe, feasible and minimally invasive proce- dure, which can lead to beautiful postoperative appearance and good upper limb function.