中国实用外科杂志

中国实用外科杂志

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乳腺癌新辅助化疗后腋窝反向淋巴作图安全性研究

张明亮，钱    军，谢    强，郭晨旭，张立功，许    睿   

  1. 蚌埠医学院第一附属医院肿瘤外科，安徽蚌埠 233004
  • 出版日期:2019-10-01 发布日期:2019-10-10

  • Online:2019-10-01 Published:2019-10-10

摘要：

目的    探讨乳腺癌经新辅助化疗（NAC）后行腋窝反向淋巴作图（ARM）的可行性及安全性。方法    回顾性分析2015年1月至2018年7月蚌埠医学院第一附属医院肿瘤外科收治的行NAC达ycN0的45例乳腺癌病人的临床资料。腋窝淋巴结处理方法包括双示踪前哨淋巴结活检（SLNB）、腋窝淋巴结清扫（ALND），其中部分病人因SLNB失败或前哨淋巴结（SLN）阳性改行ALND。所有病人术中均行亚甲蓝染料法ARM。分析术中ARM施行情况、淋巴结保留的效果及安全性。结果    ARM淋巴结保留13例，ARM淋巴结切除32例。随访截至2019年6月，随访时间为37.5（12~48）个月。ALND组和SLNB组ARM成功率分别为93.1%（27/29）和40%（8/20）。ARM淋巴结与SLN重叠3例，ARM淋巴结肿瘤转移1例。ARM淋巴结保留病人术后上肢水肿发生率显著低于ARM淋巴结切除者（P=0.010），腋窝局部复发率差异无统计学意义（P=1.000）。结论    对于NAC后达ycN0的乳腺癌病人，术中行ARM成功率较高，ARM淋巴结肿瘤转移率低，安全可行。

关键词: 乳腺癌, 新辅助化疗, 腋窝反向淋巴作图, 安全性

Abstract:

Safety of axillary reverse lymphatic mapping after neoadjuvant chemotherapy for breast cancer：A follow-up study        ZHANG Ming-liang，QIAN Jun，XIE Qiang，et al. Department of Surgical Oncology，the First Affiliated Hospital of Bengbu Medical College，Bengbu 233004，China
Corresponding author：QIAN Jun，E-mail：19257387@qq.com
Abstract    Objective    To explore the feasibility and safety of axillary reverse lymphatic mapping (ARM) after neoadjuvant chemotherapy (NAC) for breast cancer. Methods    The clinical data of 45 breast cancer patients whom reached ycN0 after being treated with NAC in the First Affiliated Hospital of Bengbu Medical College between January 2015 and July 2018 were analyzed retrospectively. Double tracer SLNB，directly ALND，or ALND followed by SLNB failure/SLN+ were performed according to the indication of the disease. All the patients were performed ARM using methylene blue dye during operation. The success rate of ARM mapping，tumor invasion rate and the safety of ARM lymph node retention were  analyzed statistically. Results    There were 13 patients in the ARM lymph node retention group and 32 patients in the ARM lymph node resection group. Follow-up was up to June 2019，the median follow-up time was 37.5 (12-48)months. Discovery rate of ARM in ALND and SLNB group was 93.1% (27/29) and 40% (8/20) respectively. ARM lymph node and SLN overlap was 3 cases. ARM lymph node tumor metastasis was 1 case. Incidence rate of upper limb edema after surgery was lower in ARM reserved group than excision group（P=0.010）. The differences of local recurrence rate between ARM reserved group and excision group was not significant （P=1.000）. Conclusion    For breast cancer patients with ycN0 after neoadjuvant therapy，reverse axillary lymph node mapping has a high success rate and a low tumor metastasis rate，which is safe and feasible.

Key words: breast cancer, neoadjuvant chemotherapy, axillary reverse lymphatic mapping, safety