早期乳腺癌前哨淋巴结活检术替代腋窝淋巴结清扫术的临床研究

Sentinel lymph node biopsy replaces axillary lymph node dissection for patients with early breast cancer

目的：探讨前哨淋巴结活检术（sentinel lymph node biopsy，SLNB）替代腋窝淋巴结清扫（axillary lymph node dissection，ALND）在早期乳腺癌患者中的应用价值和安全性。方法回顾性分析大连医科大学附属第二医院在2011年6月至2014年6月期间行SLNB和ALND患者术后上肢并发症、腋窝局部复发及远处转移情况。随访至2014年11月，中位随访时间41（18～52）个月。结果 SLNB组术后上肢并发症发生率较ALND组少，差异有统计学意义（麻木疼痛χ2＝18.174，P＝0.000；活动受限χ2＝20.413，P＝0.000；肌力减退χ2＝23.785， P＝0.000，P＜0.05），腋窝局部复发及远处转移率差异无统计学意义（χ2＝0.555，P＝0.516，P＞0.05）。结论在SLN阴性早期乳腺癌中，SLNB可取得与ALND相同的疗效；同时，SLNB与ALND相比手术创伤小，术后并发症少。

Objective To study the application value and safety of sentinel lymph node biopsy （ SLNB） replacing axillary lymph node dissection （ ALND） for patients with early breast cancer .Methods Data was col-lected for patients undergoing SLNB or ALND in the Second Hospital of Dalian Medical University from June 2011 to June 2014.The complication of upper extremity , axillary local recurrence and distant metastasis were retro-spectively analyzed.The patients were followed up to Nov .2014, with the median follow-up of 41 （ 18-52 ） months.Results Patients undergoing SLNB had less postoperative complications of upper extremity （ numb and painχ2 =18.174, P =0.000;Restricted movement χ2 =20.413, P =0.000; Strength loss χ2 =23.785, P =0.000;P＆lt;0.05）.There was no statistical difference for the postoperative complications of axillary local recur-rence and distant metastasis （χ2 =0.555, P=0.516; P＆gt;0.05）.Conclusion In early breast cancer without SLN, SLNB can achieve the equivalent effect to ALND with less damage and complications .