中国肿瘤临床
中國腫瘤臨床
중국종류림상
CHINESE JOURNAL OF CLINICAL ONCOLOGY
2013年
21期
1296-1299
,共4页
喻大军%钱军%李靖%张珂
喻大軍%錢軍%李靖%張珂
유대군%전군%리정%장가
腋窝反向作图%乳腺癌%腋窝淋巴清扫%淋巴水肿
腋窩反嚮作圖%乳腺癌%腋窩淋巴清掃%淋巴水腫
액와반향작도%유선암%액와림파청소%림파수종
axillary reverse mapping%breast cancer%axillary lymph node dissection%lymphedema
目的：研究腋窝反向淋巴作图（axillary reverse mapping，ARM）对上肢淋巴回流管网的辨别和保护作用及对减少腋窝淋巴结清扫术后上肢水肿的作用。方法：选取2009年6月至2011年5月蚌埠医学院第一附属医院肿瘤外三科300例单侧乳腺癌患者，在进行腋窝淋巴结清扫前，经上臂内侧肌间沟皮下注射亚甲蓝2～3 mL，对上肢来源的淋巴管和淋巴结进行染色，术中加以辨别和保护。术后2个月测量双上臂周径差异（患侧臂周径-健侧臂周径≥2 cm为淋巴水肿），记录淋巴水肿的发生情况。结果：300例患者中有195例作图成功，成功率65%。分别于术后6、12、18、24个月进行随访，发现和同期作图失败患者相比较，作图成功患者淋巴水肿的发生率明显降低，差异具有显著性统计学意义。结论：通过腋窝反向淋巴作图（ARM）可以辨别保护上肢回流的淋巴管道，对预防乳腺癌腋窝淋巴结清扫术后上肢水肿具有临床意义。
目的：研究腋窩反嚮淋巴作圖（axillary reverse mapping，ARM）對上肢淋巴迴流管網的辨彆和保護作用及對減少腋窩淋巴結清掃術後上肢水腫的作用。方法：選取2009年6月至2011年5月蚌埠醫學院第一附屬醫院腫瘤外三科300例單側乳腺癌患者，在進行腋窩淋巴結清掃前，經上臂內側肌間溝皮下註射亞甲藍2～3 mL，對上肢來源的淋巴管和淋巴結進行染色，術中加以辨彆和保護。術後2箇月測量雙上臂週徑差異（患側臂週徑-健側臂週徑≥2 cm為淋巴水腫），記錄淋巴水腫的髮生情況。結果：300例患者中有195例作圖成功，成功率65%。分彆于術後6、12、18、24箇月進行隨訪，髮現和同期作圖失敗患者相比較，作圖成功患者淋巴水腫的髮生率明顯降低，差異具有顯著性統計學意義。結論：通過腋窩反嚮淋巴作圖（ARM）可以辨彆保護上肢迴流的淋巴管道，對預防乳腺癌腋窩淋巴結清掃術後上肢水腫具有臨床意義。
목적：연구액와반향림파작도（axillary reverse mapping，ARM）대상지림파회류관망적변별화보호작용급대감소액와림파결청소술후상지수종적작용。방법：선취2009년6월지2011년5월방부의학원제일부속의원종류외삼과300례단측유선암환자，재진행액와림파결청소전，경상비내측기간구피하주사아갑람2～3 mL，대상지래원적림파관화림파결진행염색，술중가이변별화보호。술후2개월측량쌍상비주경차이（환측비주경-건측비주경≥2 cm위림파수종），기록림파수종적발생정황。결과：300례환자중유195례작도성공，성공솔65%。분별우술후6、12、18、24개월진행수방，발현화동기작도실패환자상비교，작도성공환자림파수종적발생솔명현강저，차이구유현저성통계학의의。결론：통과액와반향림파작도（ARM）가이변별보호상지회류적림파관도，대예방유선암액와림파결청소술후상지수종구유림상의의。
Objective:To assess the ability of axillary reverse mapping (ARM) to identify and preserve the arm lymphatics drainage as well as determine its ability to reduce lymphedema. Methods:A total of 300 breast cancer patients who underwent axillary lymph node dissection (ALND) from June 2009 to May 2011 were enrolled in this study. Methylene blue dye (2 mL to 3 mL) was injected into the ipsilateral upper inner arm along the medial intramuscular groove to map the upper extremity lymphatic drainage system prior to ALND. The blue lymphatic and lymph nodes were identified and preserved during the operation. The change in the arm circumference was the selected method of measurement. The difference in the bilateral upper arm circumference was recorded after 2 months (difference≥2 cm is defined as lymphedema). Results:The ARM was performed successfully in 195 (65%) of 300 patients. The incidence of lymphedema was significantly lower in the successfully mapped patients than in the failing mapping patients, with statistically significant difference during follow-up at 6, 12, 18, and 24 months post operation. Conclusion:The ARM technique can identify and preserve the arm lymphatics drainage and prevent upper extremity lymphedema after breast cancer axillary lymphadenectomy.
