保乳综合治疗并前哨淋巴结活检治疗早期乳腺癌

Breast Conserving Therapy and Sentinel Lymph Node Biopsy in the Treatment of Early Breast Cancer

目的：探讨保乳综合治疗并前哨淋巴结活检（Sentinel lymph node biopsy,SLNB）在早期乳腺癌治疗中的应用价值。方法：临床纳入早期乳腺癌患者70例,患者均有保乳意愿,患者需在自愿的基础上签署SLNB手术治疗同意书。患者在保乳手术的同时进行SLNB,根据术中前哨淋巴结（Sentinel lymph node,SLN）快速冰冻病理切片检查的结果,对于SLN阳性者（设定为对照组）进行规范的腋窝淋巴结清扫（Axillary lymph node dissection,ALND）,对于SLN阴性者（设定为试验组）不进行进一步腋窝淋巴结清扫术。结果：试验组患者手术时间、住院时间、腋窝引流时间分别为（75.51±6.65）min、（11.76±1.49）d、（3.92±0.61）d,对照组患者分别为（117.60±5.46）min、（15.69±1.33）d、（7.65±0.53）d,两组比较差异均有统计学意义（P〈0.05）。SLN活检成功率为100%,其中,SLN阳性25例,SLN阴性45例,检测准确率为100%,假阳性率为0。术后对患者进行20-55个月的临床随访,平均随访42个月。试验组术后并发症发生率明显低于对照组,两组比较差异有统计学意义（P〈0.05）。两组患者术后3年生存率均为100%,无瘤生存率均为100%。结论：SLND为早期乳腺癌保乳手术方式的选择提供了重要的临床参考依据,前哨淋巴结活检并保乳综合治疗是早期乳腺癌一种很好的治疗手段,有效减轻手术创伤和术后并发症。

Objective： To investigate the value of breast conserving therapy and sentinel lymph node biopsy （Sentinel lymph node biopsy, SLNB） in the treatment of early breast cancer. Method： 70 patients with early breast cancer were selected in our hospital, all of them had SLNB during breast cancer surgery, according to intraoperative sentinel lymph node （Sentinel lymph node, SLN） rapid frozen section examination results, for SLN positive patients received breast conserving surgery modified radical mastectomy with standard axillary lymph node dissection （Axillary lymph node dissection, ALND）, for SLN negative, then breast conserving combined with simplified ALND （only resection of pectoralis minor lateral group, LevelⅠ）.Result： The simplify operation time, the patients hospitalization time, axillary drainage time was （75.51±6.65）min, （11.76±1.49）d, （3.92±0.61）d, the standard group was （117.60±5.46）min, （15.69±1.33）d, （7.65±0.53）d, the index had significant difference （P〈0.05）. The success rate of SLN biopsy was 100%. Among them, 25 cases were SLN positive, 45 SLN negative patients, the detection accuracy rate was 100%, false positive rate was 0. Postoperative clinical follow-up was 20-55 months for the patients with a mean follow-up of 42 months. The overall survival rate of the two groups after 3 year was both 100%, disease free survival rate was 100%.Conclusion： SLNB provides an important choice for the surgical treatment choices for early breast cancer.