乳腺癌前哨淋巴结立体定位的研究

Research of three-dimensional localization for sentinel lymph node of breast cancer

目的 研究乳腺癌前哨淋巴结（SLN）的立体位置,探索根据空间位置直接摘取前哨淋巴结.方法 术前B超检查40例乳腺癌患者同侧腋下淋巴结;彩色多普勒B超检查腋动脉及肩胛下动脉分叉点及其走向,并在体表定位.术中亚甲蓝染色运用乳腔镜找见前哨淋巴结,根据解剖位置,确定前哨淋巴结的所属淋巴组群及空间位置和体表投影.结果 40例患者通过乳腔镜下跟踪蓝染淋巴管39例找到SLN,其中4例（10.26％）的SLN位于肩胛下组,34例（87.18％）位于中央组.肩胛下组及中央组的空间位置如下：肩胛下动脉根部为起点,肩胛下动脉为直径,开始向下方作一直径为5 cm的圆,以背阔肌为底,通过该圆向腋窝中央作类圆柱体,高度达肋间臂神经表面,并以其作为类圆柱体表面圆的直径,圆心为肩胛下动脉体表投影与肋间臂神经相交处.类圆柱体的高随患者胖瘦而异,一般高度≤5 cm.术前彩色B超定位的15例肿大淋巴结均位于类圆柱体内,全部为SLN.结论 SLN立体位置位于肩胛下组和中央组淋巴结空间位置组成的类圆柱体内;彩色B超检查同侧腋窝肿大淋巴结且定位在类圆柱体内,即可认为是前哨淋巴结.在类圆柱体的体表作一与肋间臂神经平行且与肩胛下动脉体表投影相交的约5 cm的切口,向肩胛下动脉起始部解剖,即可找到前哨淋巴结.

Objective To investigate three-dimensional localization for sentinel lymph node （SLN） of breast cancer,and by which we can remove the SLNs directly.Methods The ipsilateral axillary lymph nodes of 40 patients were inspected by B-ultrasound and axillary artery and subscapular artery bifurcation point and its trend with Doppler B-ultrasound in the preoperation,then located them in the surface.We found SLNs using methylene blue as the mapping agent with endoscope during the operation,determined which lymphatic group the sentinel lymph node belonged and the spatial location and the surface projection according to the anatomical location.Results We found the three-dimensional location of SLNs in the group of 39 in 40 patients with endoscope,of which 34 cases located in central group,accounting for 87.18% ;while 4 cases located in the subscapular group,accounting for 10.26%,and their spatial location was as follows：set the root of subscapular artery in this location as a starting point,the subscapular artery as a diameter,and made a diameter of 5cm circle to the bottom,then let the latissimus dorsi as the end,and made a quasi-cylinder through the circle to the axillary central.The height of the quasi-cylinder got up to the surface of the intercostal brachial nerve.Then set the nerve as the diameter of circle of quasi-cylinder,and the centre of circle was crosspoint of subscapnlar artery＇s surface projection with intercostal brachial nerve.The height of quasi-cylinder varies with somatotypes of the patients,its height was less than or equal to 5cm.What＇s more,the fiften enlarged lymph nodes located by B-ultrasound in the preoperation were all in the quasi-cylinder,and they were SLNs.Conclusion SLN lies in quasi-cylinder consisting of spatial location of subscapular group and central group lymph nodes.If the enlarged lymph nodes found by B-ultrasound are in above mentioned quasi-cylinder,they can be considered as the SLNs.Make a 5cm-incision parallelling the intercostal brachial nerve and intersecting the surface projection of subscapular artery in the surface of quasi-cylinder,then dissect toward the origin of the subscapular artery,you can find SLNs.