保腋窝手术在单个前哨淋巴结活检阳性的早期乳腺癌中的应用价值

The application value of conservative axillary surgery in treatment of early stage breast cancer with positive single sentinel lymph node biopsy

目的探讨单个前哨淋巴结活检(SLNB)阳性的早期乳腺癌患者行保腋窝手术的可行性。方法 78例单个SLNB阳性的早期乳腺癌按照随机数字表法随机分为保腋窝组和非保腋窝组,各39例。比较保腋窝乳腺癌根治术与传统乳腺癌根治术的手术疗效、术后并发症。对患者随访至少2年,比较两组患者的临床转归。结果与非保腋窝组比较,保腋窝组手术时间、拔管时间明显缩短,术中出血量及引流量明显减少,术后麻木、疼痛、僵硬、活动受限、肌力减退及肿胀的发生率显著降低(P<0.05)。随访期间,两组非SLN阳性率、复发率及转移率比较,差异均无统计学意义(P>0.05)。结论单个SLNB阳性保腋窝手术在早期乳腺癌根治术中是存在可行性的,不仅可达到与腋窝淋巴结清扫同样的临床效果,还可减少术后并发症,提高患者的生存质量。

Objective To explore the feasibility of conservative axillary surgery in treatoent of early stage breast cancer with single pos tive sentinel lymph node biopsy （SLNB）. Methods 78 early stage breast cancer patients with single positive SLNB were divided into non - conservative axillary surgery group （ n = 39） and conservative axillary surgery group （n = 39） according to the random number table method. The curative effect and postoperative complications of surgery between radical mastectomy without axillary lymph node dissection （ ALND） and axillary lymph node dissection were compared. All patients were followed up for at least 2 years, the clinical outcomes between two groups were compared. Results In comparison with non - conservative axillary surgery group, the operating time and duration for extubation in patients of conservative axillary group were obviously shortened, amount of intraoperative blood loss and drainage were significantly decreased, and the incidence of numbness ,pain, stiffness, limited activity, decreased musclar strength and swelling in conservative axillary surgery group were also significantly reduced （P 〈 0. 05）. During the follow - up period, there was no significant difference in the positive rate of non SLN, recurrence and metastasis between these two groups （ P 〉0.05） . Conclusion Conservative axillary surgery in early stage breast cancer with single positive SLNB is feasible, it not only can achieve the same clinical effect as the ALND, but it can also reduce the postoperative complications and improve the quality of life of patients.