上臂淋巴回流与腋窝淋巴结的应用解剖关系及意义

Applied anatomical relation between upper arm lymphatic drainage and axillary lymph node,and its significance

目的:为乳腺癌病人行前哨淋巴结活检(SLNB)及腋窝淋巴结清扫术(ALND)中,保留上臂淋巴回流,减轻上臂淋巴水肿提供解剖学依据。方法:对20具成人女性尸体的40侧腋区及近侧上臂区进行解剖,观察腋区各组淋巴结的数量、位置及近侧上臂浅表淋巴回流与腋区淋巴结、腋静脉三者的关系。结果:外侧群淋巴结数目为(3±1.3)个,肩胛下群淋巴结数目为(4±1.8)个,胸肌群淋巴结数目为(4±1.1)个,中央群淋巴结数目为(5±1.3)个,尖群淋巴结数目为(2±1.3)个,上臂浅层淋巴管有分支汇入贵要静脉12例(30.0%),至腋窝主要汇入外侧群淋巴结25例(62.5%),中央群淋巴结13例(32.5%);并有分支直接汇入液静脉20例(50.0%)。结论:ALND和SLNB术中保留反向淋巴作图淋巴管及淋巴结可有效保障上臂淋巴回流。

Objective: To provide the anatomical basis in preserving the upper limb lymphatic drainage to alleviate upper limb lymphedema during the sentinel lymph node biopsy (SLNB)and axillary lymph node(ALN) dissection(ALND) in breast cancer patients. Methods: The axillary region and proximal upper arm region of 40 sides in female adult cadavers were dissected,and the number and location of lymph node in each axillary region were observed.The relationships among the superficial lymphatic reflux of proximal upper arm,axillary lymph node and axillary vein were analyzed. Results: The average number of lateral ALN,subscapularis ALN,pectoral ALN,central ALN and apical ALN was(3±1.3)(4±1.8)(4±1.1)(5±1.3) and (2±1.3),respectively.The superficial lymphatic drainage of upper limb draining into basilic vein in 12 cases(30.0%),lateral ALN in 25 cases(62.5%),central ALN in 13 cases (32.5%) and axillary vein in 20 cases(50.0%) were identified. Conclusions: Preservating the axillary reverse mapping lymphatic drainage and lymph nodes during ALND and SLNB can effectively protect the upper limb lymphatic drainage.