LevelⅢ组淋巴结清扫在腋下淋巴结阳性乳腺癌改良根治术中的应用

The application of dissecting level Ⅲ lymph nodes in modified radical mastectomy of breast cancer with positive axillary lymph nodes

目的:探讨LevelⅢ组淋巴结清扫在腋下淋巴结阳性乳腺癌改良根治术中的应用价值。方法:对术前通过体检或超声影像学检查发现腋下淋巴结阳性59例,行单纯乳腺癌改良根治术或结合Ⅲ组淋巴结清扫术,比较2种术式的治疗效果。结果:Ⅲ组淋巴结清扫患者42例,其中41例腋下淋巴结阳性,伴有Ⅲ组淋巴结阳性者13例,3年远处转移率为9.5%,锁骨上淋巴结转移率2.4%;单纯乳腺癌改良根治患者17例,3年远处转移率为35.3%,锁骨上淋巴结转移率23.5%,2组差异均有统计学意义(P<0.05);Ⅲ组淋巴结清扫患者总生存率为92.9%,单纯乳腺癌改良根治患者为88.2%,2组差异无统计学意义(P>0.05)。结论:对于术前发现腋下淋巴结阳性者,行Ⅲ组淋巴结清扫可提高腋窝淋巴结清扫彻底性,并对术后的合理治疗和提高预后有重要的指导意义。

Objective：To evaluate the value of dissecting levelⅢlymph nodes in modified radical mastectomy of breast cancer patient with positive axillary lymph nodes. Methods：The breast carcinoma patients with positive axillary lymph nodes were screened by physical examination or ultrasound imaging. The patients were treated with the modified radical mastectomy or modified radical mastectomy combined with level Ⅲ lymph nodes dissection. The clinical effects of two kinds of operations were compared. Results：Forty-two patients were treated with level Ⅲ lymph nodes dissection. Among 42 patients, the positive axillary lymph nodes in 41 cases （ accompanied by postive level Ⅲ lymph nodes in 13 cases ） were found. The rates of 3-year distant metastasis and supraclavicular lymph node metastasis were 9. 5% and 2. 4%,respectively. Seventeen patients were treated with the modified radical mastectomy,the rates of 3-year distant metastasis and supraclavicular lymph node metastasis were 35. 3% and 23. 5%,respectively. The differences of the rates of 3-year distant metastasis and supraclavicular lymph node metastasis between two kinds of operations were statistically significant（P〈0. 05）. The overall survival rates of the patients treated with the modified radical mastectomy and modified radical mastectomy combined with level Ⅲ lymph nodes dissection were 92. 9% and 88. 2%,respectively,the difference of which was not statistically significant（P〉0. 05）. Conclusions：Dissecting level Ⅲ lymph nodes in the treatment of the patients with positive axillary lymph nodes can thoroughly clean the axillary lymph nodes,and improve the postoperative treatment and prognosis.