吸脂术在乳腺癌腋窝淋巴结清扫术中的应用

Liposuction in axillary lymph node dissection in breast cancer

目的探讨吸脂术在乳腺癌腋窝淋巴结清扫术中的临床意义。方法 2013年1月至2017年1月120例乳腺癌患者,随机分为观察组及对照组各60例,观察组先于腋窝注射脂肪溶解液15 min后行吸脂术,继而进行淋巴结清扫术;对照组行传统腋窝淋巴结清扫术。比较两组手术时间、术中出血量、术后引流管总引流量,患肢疼痛、水肿及提肩运动障碍等相关并发症情况。结果与对照组相比,观察组腋窝淋巴结清扫数目多[(16.1±4.2)枚vs(12.2±4.8)枚],手术时间长[(113.7±15.8)min vs(96.6±14.3)min],术中出血量少[(75.9±16.6)ml vs(112.4±12.2)ml],拔管时间短[(5.1±0.2)d vs(10.8±1.4)d],术后第1、2、3、4天引流管总引流量少,差异有统计学意义(P均<0.01)。观察组术后上肢疼痛、提肩运动障碍、上肢水肿发生率均低于对照组(P<0.05,P<0.01)。结论吸脂术在乳腺癌腋窝淋巴结清扫术中能够清晰暴露腋窝区域重要的神经和血管,使视野更加清晰,能够彻底地清扫淋巴组织,进而减少的手术相关并发症。

Objective To explore the clinical significance of liposuction in the axillary lymph node dissection（ ALND） of breast cancer. Methods A total of 120 patients with breast cancer from January 2013 to January 2017 were randomly divided into observation group and control group（ n = 60,each）. The liposuction and ALND were successively performed 15 ministers after axillary injection of fat-soluble liquid in observation group,and conventional ALNDwas performed in control group. The operation time,intraoperative bleeding,total drainage volume after operation and related complications of limbs pain,swelling and limited mobility were compared between two groups. Results The number of cleaned lymph node（ 16. 1± 4. 2 vs 12. 2 ± 4. 8） in observation group was significantly more than that in control group,and operation time [（ 113. 7 ±15. 8） min vs（ 96. 6 ± 14. 3） min] in observation group was significantly longer than that in control group（ P〈0. 05,P〈0. 01）. Intraoperative blood loss [（ 75. 9 ± 16. 6） ml vs（ 112. 4 ± 12. 2） ml],tube extraction time[（ 5. 1 ± 0. 3） d vs（ 10. 8± 1. 4） d] and total drainage volume after operation in observation group significantly decreased compared with control group（ P〈0. 05,P〈0. 01）. The incidence of limb pain,swelling and shoulder movement disorder in observation group was significantly lower than that in control group（ P〈0. 05,P〈0. 01）. Conclusion Liposuction in axillary lymph node dissection for breast cancer can clearly expose the important nerves and blood vessels in axillary region to clean the lymphatic tissue completely,thereby reducing the postoperative complications.