腔镜腋窝淋巴结清扫与传统腋窝淋巴结清扫对保乳手术美容效果影响的比较

A Comparison of Cosmetic Outcomes between Endoscopic Axillary Lymph Node Dissection and Conventional Axillary Lymph Node Dissection for Breast Conservative Surgery

目的探讨腔镜腋窝淋巴结清扫在乳腺癌保乳手术中的美容效果。方法2007年1月-2009年12月保乳手术中行腔镜腋窝淋巴结清扫术29例（EALND组），并与同期33例传统腋窝淋巴结清扫（CALND组）进行比较，根据调查问卷和术后6个月以上站立位乳房照片评价术后乳房的美容效果。结果EALND组无中转开放手术，未发生意外损伤、皮下气肿、脂肪栓塞等并发症。EALND组清扫腋窝淋巴结（18．2±5．9）枚，显著多于CALND组（14．9±3．6）枚（t=2．694，P=0．009）。平均随访时间49．2月（36—69个月）。EALND组主观满意度优良率89．7％（26／29），明显高于CALND组69．7％（23／33；Z=-2．509，P=0．012）；EALND组美容效果客观评分优良率86．2％（25／29），明显高于CALND组75．8％（25／33；Z=-2．295，P=0．022）。结论腔镜腋窝淋巴结清扫术不仅能够达到传统腋窝淋巴清扫的治疗效果，而且具有缩小手术切口、改善保乳手术后乳房美容效果等优点。

Objective To evaluate the cosmetic outcomes of endoscopic axillary lymph node dissection （EALND） in breast conserving surgery （BCS）. Methods A total of 31 patients who received BCS and EALND from January 2007 to December 2009 were enrolled as EALND group, whereas 35 patients who underwent conventional axillary lymph node dissection （CALND） in the same period were selected as CALND group. Clinical data of the patients were analyzed retrospectively. The data were gathered by using a questionnaire including patients＇ cosmetic scores and satisfaction. Postoperative breasts photographs were evaluated by using physician cosmetic scores. Results In the EALND group, there were no complications such as accidential injury, subcutaneous emphysema, or fat embolism, without conversion to open surgery. The number of lymph node dissected was significantly more in the EALND group （18.2±5.9） than that in the CALND group （14.9 ±3.6） （t =2.694, P =0.009）. The mean duration of follow-up was 49.2 months （ range, 36 - 69 months）. The EALND group showed a higher patient satisfaction [ 89.7% （26/29） vs. 69.7% （23/33）, Z = - 2. 509, P =0. 012] and a higher cosmetic scores [86.2% （25/29） , vs. 75.8% （25/33） , Z = - 2. 295, P =0. 022] than those of the CALND group. Conclusion EALND has the same therapeutic results but significantly smaller incision and better cosmetic outcomes compared with CALND.