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目的研究通过前哨淋巴通道(SLC)行前哨淋巴结活检(SLNB)以指导保留乳房手术(breast-conserving therapy,BCT)患者行选择性腋窝淋巴结清除术(ALND)的可行性。方法采用非随机对照研究,在BCT患者中采用联合示踪法通过SLC行SLNB。对术中检出的前哨淋巴结(SLN)行细胞印片和冰冻切片检查,根据SLN的术中病理结果行选择性ALND,其中SLN阳性、行ALND者为A组,SLN阴性仅行SLNB者为B组。定性资料的比较选用χ2检验,两组均数的比较采用t检验。结果 2009年1月至2009年12月采用联合示踪法行SLNB的BCT患者共43例,检出42例,A组28例,B组14例。两组患者的SLC均被显影。每例患者被检出SLN1～3枚,平均1.4枚,共被检出59枚。SLNB检出率为97.7%(42/43)。术后病理检查共检出阳性SLN29例,其中术中细胞印片、冰冻切片及二者联合病理检测分别检出阳性淋巴结27、27、28例。A组ALND相关并发症发生率明显高于B组(P=0.003)。结论通过SLC行SLNB有助于准确定位SLN,能够指导BCT患者行选择性ALND,降低术后并发症。
Objective To investigate the feasibility of selective axillary lymph node dissection (ALND) in patients undergoing breast-conserving therapy (BCT) with sentinel lymph node biopsy (SLNB) through the sentinel lymph node (SLC). Methods A nonrandomized controlled trial of SLNB was performed by SLC in a cohort of BCT patients. Sentinel lymph nodes (SLNs) detected by intraoperative cytological staining and frozen section examination, according to SLN intraoperative pathological results of selective ALND, which SLN positive, line ALND were A group, SLN negative line only SLNB was Group B. Qualitative data comparison using χ2 test, the two groups were compared using t test. Results From January 2009 to December 2009, 43 patients with BCT in SLNB were detected by combined tracing method, 42 cases were detected, 28 cases in group A and 14 cases in group B. SLC was developed in both groups. Each patient was detected SLN1 ~ 3, an average of 1.4, were detected 59. The detection rate of SLNB was 97.7% (42/43). Postoperative pathological examination were detected in 29 cases of positive SLN, including intraoperative printing, frozen sections and pathological examination of the two positive lymph nodes were detected 27,27,28 cases. The incidence of ALND related complications in group A was significantly higher than that in group B (P = 0.003). Conclusion SLNB through SLC can help locate SLN accurately and guide the selective ALND of BCT patients, reducing the postoperative complications.