前哨淋巴结切除术治疗早期乳腺癌的疗效观察

Efficacy of sentinel lymph node resection in the treatment of early breast cancer

目的探讨前哨淋巴结切除术治疗早期乳腺癌的疗效。方法102例早期乳腺癌患者,根据前哨淋巴结切除后病理提示,阴性为研究组(62例),阳性为对照组(40例)。对照组进一步接受腋窝淋巴结清扫术,研究组未进一步手术治疗。比较两组术后并发症发生情况、肩关节功能、随访结果。结果研究组术后上肢淋巴水肿、感觉减退、活动受限、皮下积液发生率分别为4.8%、6.5%、1.6%、3.2%,均明显低于对照组的40.0%、52.5%、25.0%、17.5%,差异具有统计学意义(P<0.05)。术后,两组患者肩关节屈曲活动度、外旋活动度、内旋活动度、外展活动度、后伸活动度均下降,且研究组降低程度少于对照组,差异均具有统计学意义(P<0.05)。研究组中有3例患者发生同侧腋窝淋巴结复发,复发率为4.8%,肿瘤直径2.8 cm×1.5 cm^4.2 cm×3.3 cm,接受腋窝淋巴结清扫术,术后病理证实有1~2/19个腋窝淋巴结转移。对照组术后无复发,复发率为0。两组术后的复发率比较,差异无统计学意义(P>0.05)。至末次随访,两组患者无一例发生远处转移和相关死亡,总生存率均为100.0%。结论前哨淋巴结切除术是治疗早期乳腺癌的可行方法,具有疗效好、术后并发症少、对肩关节功能损伤小等优点。

Objective To discuss the efficacy of sentinel lymph node resection in the treatment of early breast cancer.Methods A total of 102 patients with early breast cancer were divided into research group(negative,62 cases)and control group(positive,40 cases)according to pathological findings after sentinel lymph node resection.The control group received axillary lymph node dissection,and the research group did not receive further surgical treatment.The occurrence of postoperative complications,shoulder joint function and follow-up results were compared between the two groups.Results The incidence of postoperative upper limb lymphedema,hypoesthesia,restricted mobility,and subcutaneous fluid accumulation of the research group were 4.8%,6.5%,1.6%and 3.2%,which were obviously lower than 40.0%,52.5%,25.0%and 17.5%of the control group,and the difference was statistically significant(P<0.05).After operation,the shoulder joint flexion range,external rotation range,internal rotation range,abduction range,and extension range decreased in the two groups of patients,and the reduction in the research group was less than that in the control group,and the difference was statistically significant(P<0.05).In the research group,3 patients had ipsilateral axillary lymph node recurrence,the recurrence rate was 4.8%,the tumor diameter was 2.8 cm×1.5 cm-4.2 cm×3.3 cm,and underwent axillary lymph node dissection.Postoperative pathology confirmed 1~2/19 axillary lymph node metastasis.The control group had no recurrence after operation,and the recurrence rate was 0.There was no statistically significant difference in recurrence rate between the two groups(P>0.05).At the last follow-up,no patients in the two groups had distant metastases and related deaths,and the overall survival rate was 100.0%.Conclusion Sentinel lymph node resection is a feasible method for the treatment of early breast cancer.It has the advantages of good curative effect,less postoperative complications,and less damage to shoulder joint function.