乳腺癌淋巴结清扫术中保留上肢淋巴结的疗效分析

Influence of upper limb lymph node retention on effect of lymph node dissection for breast cancer

目的在探讨乳腺癌淋巴结清扫术中保留上肢淋巴结对淋巴水肿及生活质量的影响。方法选取2013年1月-2014年12月于贵州省人民医院乳腺科收治的100例T1-3No Mo期乳腺癌患者,根据患者及其家属协商选择的手术方法将研究对象分为观察组和对照组,每组各50例。观察组术前以纳米炭混悬液行经上臂逆行腋窝淋巴结示踪术;对照组行腋窝淋巴结清扫术。于术后1、6及12个月时对两组患者进行随访,记录并比较两组患者随访期间各时间点患侧比健侧上肢臂围增加的百分比,术后12个月时上肢淋巴水肿发生情况,各时间点乳腺癌患者生命质量测定量表(FACT-B)评分。结果两组术后1、6及12个月患侧比健侧上肢臂围增加的百分比比较,差异有统计学意义(P<0.05)。此外,两组12个月时上肢淋巴水肿总发生率比较,差异有统计学意义(P<0.05);在预防上肢淋巴水肿的效果方面,观察组的优良率高于对照组(P<0.05)。与治疗前相比,观察组的生活质量评分降低,且两组随访期间各时间点的评分比较,差异有统计学意义(P<0.05)。结论保留上肢淋巴结的乳腺癌淋巴结清扫术可以有效地预防患者上肢淋巴水肿,改善患者的生活质量,值得在临床上推广使用。

Objective To investigate the influence of retention of upper-limb lymph nodes on lymphedema and the quality of life in patients having lymph node dissection for breast cancer. Methods From January 2013 to December 2014, 100 patients with T1-3N0M0 breast cancer who underwent surgery in our hospital were randomly divided into observation group and control group with 50 in each group. The patients in the observation group received axillary reverse mapping with nano-carbon suspension before operation. The patients in the control group were treated with axillary lymph node dissection. The patients were followed up in the 1st, 6th and 12th months after operation. Lymphedema and the quality of life were compared between the two groups. Results The percentages of increased arm circumference in the affected arm 1, 6 and 12 months after operation were not statistically different between the two groups （P 〈 0.05）. In addition, the incidence of lymphedema 12 months after operation in the observation group was signifcantly lower than that in the control group （P 〈 0.05）. The score of the quality of life in the observation group decreased after operation, and it was signifcantly different between the two groups during follow-up （P 〈 0.05）. Conclusions Lymphadenectomy for breast cancer with upper-limb lymph node preservation can prevent lymphedema of the upper limb and improve the quality of life of the patients. It is worthy to be popularized in clinical practice.