经肌间入路淋巴结清除术对乳腺癌术后复发锁骨下第3组淋巴结的清除效果探讨

The effect of lymph node clearance in subclavian group 3 after breast cancer

目的:探讨经肌间入路淋巴结清除术对乳腺癌术后复发锁骨下第3组淋巴结的清除效果。方法:收集驻马店市中医院2019年5月至2022年5月收治的92例乳腺癌术后锁骨下第3组淋巴结复发患者的临床资料,所有患者均行乳腺癌淋巴结清除术,根据其手术入路的不同将经胸大肌肌间行锁骨下第3组淋巴结清除的46例患者分为肌间入路组,经腋窝行锁骨下第3组淋巴结清除的46例患者分为腋窝入路组。比较两组手术相关指标、淋巴结清除效果、炎症相关因子水平、并发症发生率以及复发转移情况。结果:肌间入路组手术时间、术中出血量少于腋窝入路组(P<0.05),但两组引流管留置时间、总引流量、住院时间对比无差异(P>0.05);肌间入路组锁骨下区域第3组、胸大小肌间、腋窝平均淋巴结清除数均高于腋窝入路组(P<0.05);术后第1 d,两组hs-CRP、PCT均较术前升高,但两组对比无差异(P<0.05);肌间入路组淋巴水肿、胸大肌萎缩发生率低于腋窝入路组(P<0.05),其余并发症发生率对比无差异(P>0.05);肌间入路组远处转移率低于腋窝入路组(P<0.05),但两组局部复发率对比无差异(P>0.05)。结论:在乳腺癌术后复发锁骨下第3组淋巴结的手术治疗方面,经肌间入路与腋窝入路手术恢复效果相当,且不影响患者术后炎症相关因子水平,但相较而言,经肌间入路手术创伤更小,可减少术后并发症的发生,还可使淋巴结清除更彻底,降低淋巴结远处转移率。

Objective:To investigate the effect of lymph node clearance on subclavian group 3 after the recurrence of breast cancer.Methods:Collect clinical data of 92 patients with subclavian lymph node recurrence admitted to Zhumadian Hospital from May 2019 to May 2022.All patients underwent breast cancer lymph node removal.According to their surgical approach,46 patients with subclavicular group 3 were divided into intermuscular approach group,and 46 patients with subclavian group 3 were divided into axillary approach group.Surgery-related indicators,lymph node clearance effect,levels of inflammation-related factors,complication rate,and recurrence and metastasis were compared.Results:The operation time and intraoperative blood loss in the intermuscular approach group were less than those in the axillary approach group(P<0.05),However,there was no difference in the indwelling time,total discharge and hospitalization time between the two groups(P>0.05);In the intermuscular group,the subclavicular area were higher than those in the axillary group(P<0.05);On the postoperative 1 d,Both groups of hs-CRP and PCT were elevated compared to the preoperative,However,there was no difference between the two groups(P<0.05);The incidence of lymphedema and pectoral major muscle atrophy was lower in the intermuscular approach group than in the axillary approach group(P<0.05),There was no difference in the incidence rates of the other complications(P>0.05);The rate of distant metastasis in the intermuscular approach group was lower than that in the axillary approach group(P<0.05),However,there was no difference in the local recurrence rate between the two groups(P>0.05).Conclusion:In the surgical treatment of group 3 lymph nodes,through the intermuscle approach and axillary approach surgery recovery effect,and does not affect the level of postoperative inflammation related factors,but by comparison,through the intermuscle approach surgery less trauma,can reduce the occurrence of postoperative complications,but also can make the lymph node clearance more thoroughly,reduce the distant metastasis rate of lymph nodes.