肿胀液溶脂法对原发性乳腺癌患者腋窝淋巴结清扫手术疗效的影响

Effect of Swelling Solution Method in the Efficacy of Axillary Lymph Node Dissection for Primary Breast Cancer

目的探讨临床乳腺癌腋窝淋巴结清扫的最佳术式。方法将67例原发性乳腺癌患者按照手术方式分为肿胀液溶脂组(32例)和传统组(35例),比较2种手术方式的术中出血量、清扫淋巴结转移数目等临床参数以及术后并发症。结果 2组患者淋巴结清扫、转移数目和淋巴结病理学改变均无统计学差异(P均>0.05)。溶脂组患者术中出血量少于传统组,腋窝淋巴结清扫时间短于传统组,差异均有统计学意义(P均<0.05)。2组术中引流量、引流时间和总手术时间比较,均无统计学差异(P均>0.05)。术后溶脂组患者上肢水肿和前臂内侧麻木疼痛比例均低于传统组,差异均有统计学意义(P均<0.05);而举肩障碍率、皮下积液率和皮瓣坏死率虽低于传统组,但均无统计学差异(P均>0.05)。术后患者生活感受、健康感受和生活质量总评分方面,溶脂组高于传统组,差异均有统计学意义(P均<0.05);而日常生活和活动能力比较,2组均无统计学差异(P均>0.05)。结论肿胀液溶脂法清扫腋窝淋巴结是一种较好的术式,应在临床治疗乳腺癌中大力推广。

Objective To explore the optimal operation of axillary lymph node dissection for primary breast cancer. Methods 67 cases of primary breast cancer patients were divided into swelling liquid fat soluble group （32 cases） and the tradi- tional group （35 eases）, clinical parameters such as intraoperative bleeding and number of lymph node dissection, and postopera- tive complications were compared between the 2 groups. Results The 2 groups had no statistically significant difference in lymph node dissection, number of metastatic lymph nodes and lymph node dissection, and pathological changes （ all P 〉 0.05 ）. Com- pared with the traditional group, the bleeding volume in swelling liquid fat soluble group was lower and time needed for axillary lymph node dissection was shorter in swelling liquid fat soluble group, there had significant difference （both P 〈 0.05 ） ;while the intraoperative drainage, drainage time and total operation time had no statistically significant difference between the 2 groups （ all P 〉 0.05 ）. The postoperative rates of upper extremity edema, medial forearm pain and numbness were lower in swelling liquid fat soluble group than the traditional group, there had significant difference （ all P 〈 0.05 ）, the rates of heave shoulder disorder sub- cutaneous, effusion and necrosis of skin flap were lower in swelling liquid fat soluble group than that those of the traditional group, all had no statistical difference （ all P 〉 0.05 ）. Postoperative indexes, such as life feeling, health feeling, and total score of life quality were higher in swelling liquid fat soluble group than those of the traditional group, and the difference were statistically sig- nificant （ all P 〈 0.05）, while the activities of daily living and the ability to move were not statistically significant in the 2 groups （ all P 〉 0.05 ）. Conclusion The swelling liquid fat soluble for axillary node dissection is a better surgical method, and should be extended in breast cancer operation in clinic.