前哨淋巴结活检与腋窝淋巴结清扫术应用于早期乳腺癌根治术中的临床价值比较

Comparison of clinical value of sentinel lymph node biopsy and axillary lymph node dissection for early radical mastectomy

目的比较在早期乳腺癌根治术中应用前哨淋巴结活检(sentinel lymph node biopsy,SLNB)和腋窝淋巴结清扫术(axillary lymph node dissection,ALND)的临床价值。方法选取2016年1月~2019年1月在我院乳腺外科行根治术的92例早期乳腺癌患者(分期在T2N0M0及以下)作为研究对象,根据不同手术方式将患者分为观察组和对照组,各46例,对照组患者应用ALND,观察组患者应用SLNB,比较两组患者的手术相关数据和肩关节活动相关指标。结果观察组手术时间、拔管时间、住院时间和住院费用均少于对照组,差异有统计学意义(P<0.05);术前肩关节功能、肩关节外展度及上臂臂围差比较,差异无统计学意义(P>0.05);术后,观察组肩关节功能及外展度要大于对照组,差异有统计学意义(P<0.05);术后,观察组上臂臂围差要小于对照组,差异有统计学意义(P<0.05);观察组发生上肢麻木、疼痛、活动受限及水肿的比例明显少于对照组,差异有统计学意义(P<0.05)。结论前哨淋巴结活检应用于早期乳腺癌的患者,可以明显缩短手术时间,降低并发症的发生率,有利于肩关节活动的早期恢复,在早期乳腺癌患者行根治治疗时可优先考虑。

Objective To compare the clinical value of sentinel lymph node biopsy(SLNB)and axillary lymph node dis-section(ALND)in early radical mastectomy.Methods A total of 92 patients with early breast cancer who underwent radical surgery in the Department of Breast Surgery in our hospital from January 2016 to January 2019(staged at T2N0M0 and below)were enrolled.Subjects were divided into observation group and control group according to different surgical methods.The control group underwent ALND,and the observation group underwent SLNB,with 46 patients in each group.The surgery-related data and shoulder joint activity related indicators between two groups were compared.Results The operation time,extubation time,the hospitalization time and the hospitalization cost in the observation group were lower than those of the control group,and the difference was statistically significant(P<0.05).There was no significant difference in preoperative shoulder function,shoulder joint abduction and upper arm circumference between the two groups(P>0.05).After operation,the shoulder function and abduction of the observation group were greater than those of the control group,and the difference was statistically significant(P<0.05).After operation,the upper arm circumference of the observation group was smaller than that of the control group,and the difference was statistically significant(P<0.05).The incidence of upper limb numbness,pain,activity limitation and edema in the observation group was significantly lower than that of the control group,with statistically significant difference(P<0.05).Conclusion Sentinel lymph node biopsy used in patients with early breast cancer can significantly shorten the operation time,reduce the incidence of complications,and facilitate the early recovery of shoulder joint activity.It should be given priority in the treatment of early breast cancer patients.