手术切口选择对乳腺癌行前哨淋巴结活检成功率及皮下积液发生的影响

Effect of Operation Incision Selection on Success rate of Sentinel Lymph Node Biopsy and Subcutaneous Hydrops in Breast Cancer

目的探讨不同手术切口对乳腺癌行前哨淋巴结活检成功率及皮下积液发生情况的影响。方法回顾分析2011—2013年南昌市第三医院乳腺一科收治的乳腺癌病例,依条件排除后共132例入组。69例行乳房加腋窝横行双切口手术,63例行乳房延伸至腋窝单切口手术。比较两种手术切口方式下前哨淋巴结的检出率、患者切口引流时间以及皮下积液发生率的差异。结果单切口组与双切口组,前哨淋巴结检出率分别为96.8%与97.1%,差异无统计学意义(P>0.05)。当前哨淋巴结为阴性时,双切口组与单切口组患者术后切口引流时间比较,差异无统计学意义(P>0.05);当前哨淋巴结为阳性时,双切口组与单切口组患者术后切口引流时间比较,差异有统计学意义(P<0.05);当前哨淋巴结为阴性时,双切口组患者腋下积液发生率为23.8%,单切口组为7.5%,差异有统计学意义(P<0.05);当前哨淋巴结为阳性时,双切口组患者腋下积液发生率为28.0%,单切口组为23.8%,两组比较差异有统计学意义(P<0.05)。结论术前腋窝淋巴结评估为阴性的患者选择单切口将更有利于降低患者术后皮下积液的发生率且引流时间短于双切口组,而术前腋窝淋巴结评估为阳性的患者两种手术切口方式在术后皮下积液的发生率以及带管时间上未见差异。

Objective To investigate the effect of operation incision selection on the success rate of sentinel lymph node biopsy and subcutaneous hydrops in breast cancer.Methods A retrospective analysis of 132 cases of breast cancer were enrolled from the Third Hospital of Nanchang from 2011 to 2013.Sixty-nine cases received breast plus axillary incision surgery,and 63 cases received breast extended to axillary incision surgery.The detection rate of sentinel lymph nodes,incision drainage time and the incidence of subcutaneous effusion were compared between both groups.Results The successful rate of sentinel lymph node detection in single incision group and double incision group were 96.8% and 97.1%,respectively（P〉0.05）.When the sentinel lymph nodes were negative,the difference of drainage time between two groups had no statistical significance（P〉0.05）,the incidence of axillary hydrops of double incision group and single incision group were 23.8% and 7.5%（P〈0.05）;while when the sentinel lymph nodes were positive,the difference of drainage time between two groups had statistical significance（P〈0.05）.The incidence of axillary hydrops between two groups were 28.0% and 23.8%（P〈0.05）.Conclusion Preoperative axillary lymph node assessment is helpful for negative patients to select single incision,which is beneficial to reduce the incidence of postoperative subcutaneous effusion and drainage time in comparison with double incision group.As for positive patients,preoperative axillary lymph node assessment has no effect on the incidence of postoperative subcutaneous effusion or the time of tube between two types of surgical incision.