乳腺癌前哨淋巴结活检术中探索腋窝新分区的临床分析

Clinical study of exploring new axillary zone in sentinel lymph node biopsy of breast cancer

目的探索腋窝逆行淋巴示踪技术(ARM)在乳腺癌前哨淋巴结活检术(SLNB)中的应用,精准定位前哨淋巴结(SLN)和ARM淋巴结在腋窝的解剖分区。方法将亚甲蓝染色法示踪SLN技术与吲哚菁绿荧光染色法ARM相结合,分析天津市中心妇产科医院乳腺外科2017年6月至2018年6月期间收治的35例术前临床分期为T1-2N0M0乳腺癌患者的临床资料,对术中收集并记录患者资料,并通过具体的试验数据,分析肋间臂神经(ICBN)的解剖学定位及学形态与腋窝淋巴结的解剖关系,精准定位SLN和ARM淋巴结在腋窝的解剖分区。结果 35例患者,2例因SLN有转移癌被排除。33例纳入数据分析。3例ICBN位于距腋静脉下缘0-2.0 cm(9.09%)(ARM区),27例位于2.0-4.0 cm(81.82%)(SLN区),3例ICBN位于>4.0 cm(9.09%)(前门哨区)。在距离腋静脉下缘0-2.0 cm区域内,5例找到1-2枚ARM淋巴结;在2.0-4.0 cm区域内,33例均找到SLN,其中4例各发现1枚重合淋巴结;在>4.0 cm区域内均未找到ARM淋巴结和重合淋巴结,3例找到1-2枚SLN。结论 ICBN个体差异大,形体各异,距离腋静脉下缘的距离不等。腋静脉以下的腋窝区域可分成3个区域;距离腋静脉下缘2.0 cm的位置可作为ARM淋巴结和SLN的分界线,且SLN和ARM淋巴结存在一定比例的重合率。

Objective To explore the application of axillary reverse mapping(ARM)in breast cancer sentinel lymph node biopsy(SLNB),and to collect and record patient′s data during operation.Through the specific experimental data,the anatomical location and morphology of the intercostal brachial nerve(ICBN)and the anatomic relationship of the axillary lymph nodes were analyzed to accurately locate the anatomical division of the axillary fossa of sentinel lymph node(SLN)and ARM lymph nodes.Methods The technique of methylene blue staining for SLN combined with indocyanine green fluorescent staining for axillary reverse mapping was used to analyze the patients of Tianjin Central Hospital of Gynecology Obstetrics from June 2017 to June 2018.The clinical data of 35 patients with T1-2N0M0 breast cancer were analyzed.Results Of the 35 patients,two cases were excluded from metastatic carcinoma of the SLN.Thirty-three cases were included in the data analysis.Three cases of ICBN were located 0-2.0 cm(9.09%)from the lower edge of the iliac vein,27 cases were located at 2.0-4.0 cm(81.82%),and 3 cases of ICBN were located greater than 4.0 cm(9.09%).In the region of 0-2.0 cm from the lower edge of the iliac vein,1-2 ARM lymph nodes were found in 5 cases;in the 2.0-4.0 cm area,SLN was found in 33 cases,4 of which found 1 coincident lymph node;at>4.0 cm ARM lymph nodes and overlapping lymph nodes were not found in the cm region,and 1-2 SLNs were found in 3 cases.Conclusions Individual ICBNs vary greatly,with different shapes and distances from the lower edge of the axillary vein.The axillary region below the iliac vein can be divided into three regions:ARM region(0-2.0 cm);SLN region(2.0-4.0 cm);and sentinel gate region(>4.0 cm).The position 2.0 cm from the lower edge of the iliac vein can be used as the boundary between the ARM lymph node and the SLN.4.There is a certain proportion of coincidence rate between SLN and ARM lymph nodes.