乳腺癌新辅助化疗前腔镜前哨淋巴结活检术的临床应用

Clinical significance of endoscopic biopsy of sentinel lymph nodes in patients with breast cancer before the administration of neoadjuvant chemotherapy

目的探讨乳腺癌新辅助化疗前利用腔镜前哨淋巴结活检术评估腋窝淋巴结状态的临床效果。方法对2014年1月至2015年1月因拟行乳腺癌新辅助化疗而行前哨淋巴结活检术的59例患者资料进行分析,其中以腔镜方法完成者27例,行传统开放手术者32例。对两种术式的淋巴结检出率、检出数目、术后美容效果评分和术后并发症进行比较。结果腔镜组前哨淋巴结检出率(100%)高于开放组(96.88%),但差异无统计学意义(P=0.246)。腔镜组前哨淋巴结平均检出数为4.59±0.84个,显著高于开放组的2.19±1.04个,差异有统计学意义(P<0.001)。两组均无腋窝局部复发病例。腔镜组对手术美容效果感觉"非常满意"者比率(100%)明显高于开放组(53.13%),差异有统计学意义(P<0.001)。术后并发症:腔镜组术后上肢感觉异常发生率(3.70%)明显低于开放组(12.50%),差异有统计学意义(P=0.040)。腔镜组平均手术时间(49.78±7.32 min)长于开放组(31.53±6.09 min),差异有统计学意义(P<0.001)。结论乳腺癌新辅助化疗前利用腔镜进行前哨淋巴结活检,与传统开放手术相比,前者淋巴结检出率更高,同时可以更完整的保留上肢感觉和更好的保持美观的外形。

Objective To explore the clinical feasibility of endoscopic sentinel lymph node biopsy（SLNB）in patients with breast cancer before the administration of neoadjuvant chemotherapy. Methods A total of 59 patients with breast cancer prepared to accept neoadjuvant chemo-therapy undergoing SLNB in this hospital during January 2014 to January 2015 were studied. Among them,27 cases accepted endoscopic biopsy of sentinel lymph nodes,while 32 cases underwent open biopsy. The detection rate,number of detections,cosmetic results and complications after operation were analyzed and compared between these two groups. Results The number of detections（4. 59 ± 0. 84）in endoscopic biopsy group was obviously higher than that（2. 19 ± 1. 04）of open biopsy group,there was significant difference in detection rate between these two groups（ P 〈 0. 01）. The detection rate in endoscopic biopsy group was 100% ,while that in open biopsy group was 96. 88%（ P = 0. 246）. The operating time in endoscopic biopsy group was obviously longer than that of open biopsy group（ P 〈 0. 01）. There was no local recurrence in patients of both groups. The postoperative esthetic result in endoscopic biopsy group was better than that of open biopsy group（ P 〈 0. 01）. The protection of sen-sation of upper limbs in endoscopic biopsy group was better than that of open biopsy group（ P = 0. 040）. The average time of endoscopic surgery group（49. 78 ± 7. 32 min）was longer than the open group（31. 53 ± 6. 09 min）,the difference was statistically significant（ P 〈 0. 001）. Conclusion Endoscopic biopsy of sentinel lymph nodes before the administration of neoadjuvant chemotherapy in comparison with traditional oper-ation can retrieve sufficient sentinel lymph nodes,thus it can obtain better protection of sensation of upper limbs and postoperative esthetic results.