早期乳腺癌腋窝反向淋巴作图预防上肢淋巴水肿的研究

Study of the prevention of arm lymphedema in patients with early breast cancer by axillary reverse mapping

目的:探讨早期乳腺癌行腋窝淋巴结清扫(axillary lymph node dissection, ALND)过程中,染料法腋窝反向淋巴作图(axillary reverse mapping, ARM)的安全性及其对上肢淋巴水肿的预防作用。方法 :选取2014年1月—2016年5月接受乳腺癌改良根治术的早期浸润性导管癌患者共60例,随机均分为观察组和对照组,在ARM辅助下行ALND,观察组如无蓝染淋巴结异常肿大则予以完整保留蓝染淋巴管网系统,对照组将所有蓝染淋巴结单独取出,蓝染淋巴结与大体标本分别进行常规病理检查,观察记录两组术后第4周及12周上肢淋巴水肿发生情况。结果:观察组ARM成功染色24例(80.0%),对照组成功染色26例(86.7%);观察组N_0期16例,N_1期6例,对照组N_0期16例,N_1期10例;对照组所有蓝染淋巴结均未见癌转移,在术后不同时间观察组上肢淋巴水肿的发生率均低于对照组,差异有统计学意义。结论:在早期乳腺癌患者中以染料法开展ARM技术是可行且相对安全,在其他危险因素一致的前提下,完整保留ARM蓝染淋巴管网系统可显著降低上肢淋巴水肿的发生率。

Objective : To explore the feasibility and safety of axillary reverse mapping(ARM) with blue dye in the process of axillary lymph node dissection(ALND) and its effect on the prevention of arm lymphedema in patients with early breast cancer. Methods : Totally 60 patients with invasive ductal carcinoma who underwent modified radical mastectomy of breast cancer from January 2014 to May 2016 were randomly divided into observation group and control group averagely. All the blue stained lymph nodes and lymph ducts by ARM were recorded during the operation. The blue stained lymph nodes without abnormal enlargement in the observation group were conserved, while all the dyed nodes were dissected in the control group. Routine pathologic examination was performed on the blue stained lymph nodes and general specimen respectively to investigate the statuses of the upper extremity lymph nodes metastasis and the stages of axillary lymph nodes. The data were collected and analysed on pathological results of all the patients and arm circumferences were compared between the two groups. Results : ARM lymph nodes and lymph ducts were identified in 24 of 30(80.0%) patients in the observation group, including 16 cases graded as N0 and 6 cases graded as N1, compared with 26 of 30(86.7%) patients in the control group, including 16 cases graded as N0 and 10 cases graded as N1. All the blue stained lymph nodes dissected in the control group showed no metastasis. The incidence of arm lymphedema of the observation group showed a significant lower as compared with the values of the control group at four and twelve weeks after the surgical manipulations respectively. Conclusion : It is feasible and relatively safe to use methylene blue to carry out axillary reverse mapping in the process of axillary lymph node dissection for the patients with early invasive ductal carcinoma. Under the premise of other risk factors consistent ARM can significantly reduce the incidence of arm lymphedema.