113例乳腺癌游离腹部皮瓣乳房重建术机会性内乳淋巴结活检情况及其影响因素

Incidental internal mammary lymph node biopsy in 113 cases of breast cancer undergoingfree abdominal flap breast reconstruction and its influencing factors

目的分析游离腹部皮瓣乳房重建术中机会性内乳淋巴结活检的情况，探讨内乳淋巴结检出及转移的相关因素。方法收集2006年11月至2015年12月，以内乳血管作为受区血管的游离腹部皮瓣乳房重建术乳腺癌患者的临床资料，分析内乳淋巴结的检出率和阳性率，分析影响内乳淋巴结检出和转移的相关因素。结果113例游离腹部皮瓣乳房重建术中，共有53例乳腺癌检出内乳淋巴结，内乳淋巴结检出率为46．9％。即刻重建患者中，内乳淋巴结转移4例。检出内乳淋巴结的患者中，内乳淋巴结转移阳性率为7．5％（4／53））。Logistic多因素分析显示，肿瘤最大径、肿瘤位置和腋窝淋巴结状态与内乳淋巴结转移均无关（均P〉0．05）。结论乳腺癌患者腹部游离皮瓣重建术中，可以通过机会性内乳淋巴结活检的方法评估内乳淋巴结转移状态，检出率较高，且无需额外手术操作。腋窝淋巴结转移和肿瘤最大径可能为内乳淋巴结转移的高危因素。

Objective The aim of the current study is to determine the clinical value of incidental internal mammary lymph node biopsy in free abdominal flap breast reconstruction using internal mammary vessels as recipient vessels and to investigate the risk factors of internal nlammary lymph nodes metastasis. Methods The clinical data of all patients who underwent flee abdmninal flap breast reconstruction using internal mammary vessels as recipient vessels from November 2006 to December 2015 in the Department of Breast Surgery＇, Fudan University Shanghai Cancer Center were reviewed in the study. The incidence of internal mammary lymph node biopsy and the rate of metastasis were analyzed. Statistical analysis was conducted to evaluate the risk factm＇s of internal mammary lymph node metastasis. Results A total of 113 patients met the inclusion criteria, 53 （46.9%） of whom had internal mammary lymph nodes harvested. Four of these were positive for metastatic disease, all in immediate breast reconstructions. The incidence of metastasis was 7.5% in patients who had successful internal mammary lymph node biopsies.The multi-variate Logistic regression analysis showed that invasive tumor size, tumor location and axillary lymph node metastasis were not risk factors for internal mammary lymph node metastasis （P〉 0.05 ）. Conclusions Internal mammary lymph nodes found incidentally during recipient vessel exposure may provide important information about internal mammary lymph node metastasis in fl＇ee flap breast reconstrnetion. This approach for internal mammary lymph node biopsy reveals an appreciable success rate and is convenient in clinical practice. The size of invasive tumor and the axillary lymph node metastasis are probably associated with internal mammary lymph node nositivitv.