选择性保留上肢淋巴结对乳腺癌患者术后早期淋巴水肿的影响

Effects of Selective Retention of upper Limb Lymph Nodes on Postoperative Early Lymphedema in Patients with Breast Cancer

目的:探讨乳腺癌患者腋窝淋巴结清扫术(ALND)中选择性上肢淋巴结选择保留对术后早期淋巴水肿发生率以及预防淋巴水肿效果的影响。方法:选取乳腺癌患者300例,根据是否选择性保留上肢淋巴结分为观察组和对照组,观察组155例行逆行腋窝淋巴结示踪术(ARM),对照组145例行ALND术;于手术前、手术后1周、1月及6月时,测量两组患者术前、术后1周、1个月、6个月健侧和患侧上臂中点周径(MP)、鹰嘴上15 cm处上臂周径(C-15)以及两者总和(SUM),于术后6个月时,评价两组患者患侧腋窝附近术后6个月淋巴水肿分级情况、淋巴水肿预防效果,同时观察肿瘤以及局部复发、远处转移情况。结果:术后1周、1个月、6个月时,观察组患者患侧臂围较健侧臂围增加百分比分别低于对照组,差异有统计学意义(P<0.05);术后6个月时,观察组患者患侧淋巴水肿发生率显著低于对照组,观察组预防水肿优良率为(96.77%),显著高于对照组(69.66%),差异有统计学意义(P<0.05);术后6个月时内,两组局部无均复发病例。结论:选择性ALND术中保留上肢淋巴结可有效降低术后早期上肢淋巴水肿发生率,对上肢淋巴水肿预防效果显著。

Objective： To investigate the effect of selective upper limb lymph nodes in axillary lymph node dissection（ ALND） on the postoperative early lymphedema in patients with breast cancer. Methods： A total of 300 patients with breast cancer were divided into the observation group and the control group according to the selective retention of upper limb lymph nodes. 155 cases in observation group were treated with axillary reverse mapping（ ARM） while 145 cases in the control group were treated with ALND. The mid-arm perimeters（ MP） of normal and affected upper limbs,upper arm circumference at 15 cm above olecranon（ C-15） and their sum（ SUM） in the two groups were measured before surgery and 1 week,1 month and 6 months after surgery. The grade of lymphedema near axilla of affected side,and preventive effect of lymphedema were evaluated,and local tumor recurrence and distant metastasis were observed 6 months after surgery. Results： The detection in the 1 stweek,1 stmonth and 6 thmonth after surgery showed that the percentage of increased arm circumference of affected side to normal side in the observation group was lower than that in the control group（ P〈0. 05）. In the 6 th month after surgery,the incidence of lymphedema of affected side in the observation group was significantly lower than that in the control group（ 2. 58% vs 39. 31%） while the excellent and good rate of edema prevention was significantly higher than that in the control group（ 96. 77% vs 69. 66%,P〈0. 05）. In the 6^th month after operation,there were no recurrence in the two groups. Conclusion： Selective retention of upper limb lymph nodes can effectively reduce the incidence of postoperative early upper limb lymphedema,and significantly prevent upper limb lymphedema.