3D淋巴造影下腔镜乳腺手术与前哨淋巴结活检的疗效分析

Effect analysis of endoscopic breast surgery under 3D lymphangiography and sentinel lymph node biopsy

目的:探讨三维计算机断层扫描(3D-CT)淋巴造影精确检测前哨淋巴结(SLN)的有效性及在腔镜辅助乳腺手术(VABS)中的临床疗效。方法:纳入2020年2月至2021年10月诊治的130例乳腺疾病患者。于腋窝或乳晕周围切开2.5 cm(SLN活检术于腋窝1 cm处),采用环状乳房缩减术进行乳腺切除、SLN活检、腋窝淋巴结清扫,在视频辅助下进行乳房重建。术前1 d,患者行3D-CT淋巴造影,将SLN位置标记于皮肤上。在肿瘤上方、乳晕附近皮下注射磷胺铁2 mL,3 min后行CT,并重建生成三维图像,最后采用VABS进行SLN活检。130例乳腺癌患者施行VABS,并进行SLN活检(123例3D-CT)。结果:SLN通过3D-CT淋巴造影精确显示淋巴结转移情况及淋巴管与SLN的位置关系,共四种模式:单个导管到单个淋巴结(n=61),多个导管到一个切换淋巴结(n=32),单个管道到多个淋巴结(n=6),多个管道到多个淋巴结(n=24)。结论:SLN活检可通过3D-CT淋巴造影安全地进行,并减轻手术创伤。3D-CT淋巴造影辅助利用VABS进行精准SLN活检具有潜在的临床应用价值。

Objective:To investigate the effectiveness of 3D computed tomography(3D-CT)lymphography in the accurate detection of sentinel lymph nodes(SLN)and the efficacy of video-assisted breast surgery(VABS).Methods:From Feb.2020 to Oct.2021,130 patients with breast diseases were enrolled in this study.VABS was performed with a 2.5-cm skin incision in the axilla or p eri-mammary areola(1 cm in the axilla for SLN biopsy).The retraction method was used for mastectomy,SLN biopsy,axillary lymph node dissection,and breast was reconstructed under video assistance.One day before surgery,the patient underwent 3D-CT lymphography and the SLN position was marked on the skin.2 mL of ferric phosphamide was injected subcutaneously above the tumor and near the areola.CT was performed 3 min later and 3D images were reconstructed.Finally,SLN biopsy was performed using VABS technology.One hundred and thirty patients with breast cancer underwent VABS and SLN biopsy(123 cases of 3D-CT).Results:SLN accurately demonstrated lymph node metastasis and the relationship between lymphatic vessels and SLN by 3D-CT lymphography.There were 4 modes:single catheter to single lymph node(61 cases),multiple catheters to a switching node(32 cases),single catheter to multiple lymph nodes(6 cases),and multiple catheters to multiple lymph nodes(24 cases).Conclusions:SLN biopsy can be performed safely with 3D-CT lymphography and is less invasive to the patient,and 3D-CT lymphography-assisted SLN biopsy with VABS has potential clinical application value.