腔镜下腋窝淋巴结清扫在乳腺癌前哨淋巴结微转移根治术中的应用效果评估

Application of endoscopic axillary lymph node dissection in radical mastectomy for sentinel lymph node micrometastasis

目的探讨腔镜下腋窝淋巴结清扫(ALND)在乳腺癌前哨淋巴结微转移根治术中的应用疗效。方法选取2017年3月至2019年12月在河南省人民医院治疗的乳腺癌前哨淋巴结微转移患者64例,采用随机数字表法分为观察组(n=32)和对照组(n=30)。其中观察组患者在乳腺癌前哨淋巴结微转移根治术中行腔镜下ALND,对照组患者乳腺癌前哨淋巴结微转移根治术中行传统开放式ALND。观察两组的手术相关参数(手术时间、手术出血量、手术引流量)、并发症发生情况(上肢水肿、上肢疼痛、皮肤感觉障碍、肩关节活动障碍)、复发转移情况、不良预后发生情况(创口感染、创口水肿、乳房创口愈合不良)以及患者满意度。结果观察组的手术时间长于对照组(P<0.05);观察组的术中出血量、术中引流量少于对照组(P<0.05)。观察组患者的并发症发生率(6.25%,2/32)小于对照组(26.67%,8/30),差异有统计学意义(P<0.05)。观察组患者不良预后的发生率为15.63%,小于对照组(33.33%,P<0.05);观察组患者癌细胞转移复发与对照组比较差异未见统计学意义(P>0.05)。观察组患者对其乳房外观、术后疼痛、预后恢复情况的满意评分均高于对照组(P<0.05)。结论对于乳腺癌前哨淋巴结微转移根治术患者而言,腔镜下ALND较传统开放式ALND的应用效果更佳,虽前者手术的时间更长,但术中出血量、引流量更少,且术后并发症、不良预后发生率显著降低,患者的满意度更高。

Objective To investigate the effect of endoscopic axillary lymph node dissection(ALND)in radical mastectomy for sentinel lymph node micrometastasis.Methods Sixty-four patients with sentinel lymph node micrometastasis of breast cancer treated in Henan Provincial People’s Hospital from March 2017 to December 2019 were selected and randomly divided into observation group(n=32)and control group(n=30).Among them,the observation group underwent endoscopic ALND in radical mastectomy of sentinel lymph node micrometastasis,while the control group underwent traditional open ALND in radical mastectomy of sentinel lymph node micrometastasis.The operation related parameters(operation time,operation blood loss,operation drainage),complications(upper limb edema,upper limb pain,skin sensory disorders,shoulder joint dysfunction),recurrence and metastasis,adverse prognosis(wound infection,wound edema,breast wound healing)and patient satisfaction were observed.Results The operation time of the observation group was longer than that of the control group(P<0.05);the operation bleeding volume and drainage volume of the observation group were less than those of the control group(P<0.05).The incidence of complications in the observation group(6.25%,2/32)was lower than that in the control group(26.67%,8/30),and the difference was significant(P<0.05).The incidence of adverse prognosis in the observation group was 15.63%,which was lower than that(33.33%)in the control group(P<0.05).There was no significant difference in the cancer cell metastasis or recurrence between the two groups(P>0.05).The satisfaction scores of breast appearance,postoperative pain and prognosis in the observation group were higher than those in the control group(P<0.05).Conclusions For breast cancer patients with sentinel lymph node micrometastasis,the application effect of endoscopic ALND is better than that of traditional open ALND.Although the operation time of the former is longer,the intraoperative blood loss and drainage volume are less,and the incidence of postoperative complications and adverse prognosis is significantly reduced,and the patients’satisfaction is higher,which can be popularized in clinical application.