早期乳腺癌前哨淋巴结活检在简化腋清扫中的应用研究

Application of Sentinel Lymph Node Biopsy of Early Breast Cancer on Simplified Axillary Lymph Node Dissection

[目的]探讨早期乳腺癌患者行前哨淋巴结活检(SLNB)为阴性,行简化腋窝淋巴结清扫替代腋窝淋巴结清扫术(ALND)的临床效果。[方法]采用1%亚甲蓝染色法对65例早期乳腺癌患者行SLNB,60例成功行SLNB,其中40例SLN无转移者行简化腋窝淋巴结清扫术(简化组);20例SLN有转移者行ALND(标准组),比较两组患者术后上肢并发症的发生情况、腋窝复发及全身转移情况。[结果]简化组手术时间和腋窝引流时间比标准组明显缩短,有统计学差异(P<0.01);简化组术后患侧上肢的疼痛、肿胀、麻木症状明显较标准组少(P<0.01)。两组生存曲线没有差异。[结论]亚甲蓝染色法能够比较准确地定位乳腺癌的前哨淋巴结。简化ALND替代ALND手术时间和术后引流时间缩短,方便可行,并发症明显减少,腋窝复发率低,是早期乳腺癌患者的安全分期手术。

[Purpose] To investigate the effect of simplified axillary lymph node dissection instead of axillary lymph node dissection in SLN negative patients with early breast cancer.[Methods] A total of 65 patients diagnosed breast cancer by pathology accepted SLNB with methylene blue during operation. Sixty patients accepted SLNB successfully. Forty negative cases received simplified ALND as simplification group and 20 positive cases of axillary lymph node dissection as standard group. Limbs complications,axillary recurrences and metastasis were compared between simplification group and standard group. [Results] Operating time and axillary drainage time in simplification group were obviously less than those in the standard group（P〈0.01）. The incidence rates of postoperative pain,turgidity and numb were less in simplification group than those in standard group（P〈0.01）. However,the survival curve had no significant difference between the two groups. [Conclusion] Dye-guided SLNB in breast cancer is a rather precise method for locating SLN. Simplified ALND instead of ALND can reduce operation time and axillary drainage time.It is a safe staging surgery for early breast cancer.