上肢淋巴定位显影在乳腺癌腋窝淋巴结清扫术中的应用价值

Application of upper-arm lymphatic localization development in axillary lymph node dissection for patients with breast cancer

目的探讨纳米炭混悬注射液(卡纳琳)淋巴示踪剂在上肢淋巴定位显影辅助乳腺癌腋窝淋巴结清扫术中的应用价值。方法 45例乳腺癌患者随机分为观察组22例与对照组23例,于术前1 d用卡纳琳对上肢淋巴定位显影,2组均行乳腺癌改良根治术,观察组术中分别切除染黑淋巴结及未染黑淋巴结,对照组仅切除未染黑淋巴结。结果 2组45例均在腋窝区域定位出引流上肢淋巴液的淋巴结;观察组取出的染黑淋巴结病理均为阴性,未染黑的淋巴结中13例发生癌转移(59.10%),对照组切除的未染黑淋巴结中,17例出现癌转移(73.91%);观察组在术后1周及1、2个月均发生水肿,而对照组均未发生水肿(P<0.01)。结论卡纳琳是上肢淋巴定位显影的理想染料,上肢淋巴定位显影能有效区分乳腺癌腋窝淋巴清扫术中的上肢回流淋巴结,预防上肢水肿的发生。

Objective To explore the application of carbon nanoparticles suspension injection lymphatic tracer in the upper-arm lymphatic localization development supplementary axillary lymph node dissection （ALND） for patients with breast cancer. Methods A total of 45 patients with breast cancer were randomly divided into observation group （ n = 22） and control group （ n = 23 ）. Carbon nanopartielLes suspension injection was used 1 d before operation to perform the localization develop- ment for upper-arm lymph. Modified radical resections of breast cancer were given to both groups. Blacked lymph nodes and un-blaeked lymph nodes in the observation group were resected whereas only blacked lymph nodes were resected in the control group. Results Lymph nodes draining the lymphat- ic fluid from upper arms were localized in the axillary regions in both groups. The blacked lymph nodes of the observation group were all negative in pathology whereas 13 of patients with un-blacked lymph nodes had cancer metastasis （59.10%）. Of the patients with un-blacked lymph nodes in the control group, 17 were with cancer metastasis （73.91%）. Swelling was observed in the observation group 1 week, 1 month and 2 months after operation, but was not found in the control group （P 〈0.01 ）. Conclusion Carbon nanoparticles suspension injection is an ideal dyestuff for the upper-arm lymphat- ic localizaI：ion development, the former can effectively distinguish the upper-arm refluent lymph nodes in the ALND of breast cancer, thus preventing the development of upper-arm swelling.