CAJ | 학술논문

目的：探讨简化腋窝淋巴结清扫术( axillary lymph node dissection, ALND)在乳腺癌手术中的应用及效果。方法分析2009年1月至2013年6月间行前哨淋巴结活检( sentinel lymph node bi-opsy,SLNB)327例乳腺癌患者的临床资料,行亚甲蓝染色法 SLNB后根据前哨淋巴结( sentinel lymph node, SLN)冰冻病理结果,对 SLN阳性者行规范的 ALND, SLN阴性则行简化的 ALND (只清扫 LevelⅠ),比较两组在手术时间、术后住院时间、腋窝引流时间及术后并发症的差异。结果327例患者中,314例成功进行了SLNB,119例SLN阳性者行标准的ALND,195例SLN阴性者行简化的ALND,11例SLN阴性患者出现LevelⅠ组织淋巴结转移；简化组手术时间、术后住院时间、腋窝引流时间明显缩短,术后腋窝积液、肌力减退、活动受限、疼痛、麻木、肿胀等并发症明显减少。术后随访3~60个月,患者无腋窝淋巴结复发及远处转移。结论蓝染法SLNB是乳腺癌患者腋窝淋巴结转移状态的重要检测技术,对SLN阴性行简化的ALND,可节省医疗资源、减少术后并发症。
목적：탐토간화액와림파결청소술( axillary lymph node dissection, ALND)재유선암수술중적응용급효과。방법분석2009년1월지2013년6월간행전초림파결활검( sentinel lymph node bi-opsy,SLNB)327례유선암환자적림상자료,행아갑람염색법 SLNB후근거전초림파결( sentinel lymph node, SLN)빙동병리결과,대 SLN양성자행규범적 ALND, SLN음성칙행간화적 ALND (지청소 LevelⅠ),비교량조재수술시간、술후주원시간、액와인류시간급술후병발증적차이。결과327례환자중,314례성공진행료SLNB,119례SLN양성자행표준적ALND,195례SLN음성자행간화적ALND,11례SLN음성환자출현LevelⅠ조직림파결전이；간화조수술시간、술후주원시간、액와인류시간명현축단,술후액와적액、기력감퇴、활동수한、동통、마목、종창등병발증명현감소。술후수방3~60개월,환자무액와림파결복발급원처전이。결론람염법SLNB시유선암환자액와림파결전이상태적중요검측기술,대SLN음성행간화적ALND,가절성의료자원、감소술후병발증。
Objective To explore the application and effect of simplified axillary lymph node dissection ( ALND) in the operation of breast cancer . Methods Through the analysis of 327 cases of breast cancer pa-tients with clinical data in our department from Jan. 2009 to Jun. 2013 receiving sentinel lymph node biopsy (SLNB), according to the sentinel lymph node (SLN) frozen pathological results which were used methylene blue staining of SLNB , the patients who were SLN positive did the standard ALND, and the SLN negative pa-tients did the simplified ALND ( only clean up Level I) , Differences on operative time, postoperative hospitali-zation time, axillary drainage time and postoperative complications were compared between the two groups. Re-sults Among 327 cases, 314 cases successfully carried out SLNB, ALND in 119 cases with SLN positive and 195 cases of ALND negative SLN for simplified ALND. Above all, there were 11 SLN negative cases with the metastasis in Level I tissue lymph node. Compared to the standard ALND, the simplified ALND ( only clean up Level I) has shortened the operative time, postoperative hospitalization time, axillary drainage time obviously, and the armpit dropsy, decreased muscle strength, activity limitation, pain, numbness, swelling and other post-operative complications were reduced significantly. Patients were followed up 3 to 60 months after operation;none of patients were found axillary lymph node recurrence and distant metastasis. Conclusion Methylene blue staining of SLNB is an important detecting technique of valuing the metastasis of the axillary lymph node. Using simplified ALND on breast cancer patients who are SLN negative will save medical resources and reduce the postoperative complications.