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目的:探讨乳腺癌癌灶区段的淋巴引流途径分型,了解各型淋巴结转移差异。为研究各型乳腺癌的淋巴结转移规律及诊断和治疗方法探索新的思路。方法:收集2006年1月至2016年5月间开封市肿瘤医院行乳腺癌c T_(1-4)N_(0-1)M_0手术的患者,术前对肿瘤所在区段的瘤周腺体注射亚甲蓝,进行淋巴染色示踪,术中见淋巴结或淋巴管染色显示淋巴途径者450例,根据被染色的淋巴管走向和淋巴结尤其是前哨淋巴结(sentinellymph node,SLN)所在区域,进行乳腺癌区段淋巴引流途径分型(lymphatic drainage pathway type,LDPT),分为腋下(axillary,A)型、内乳(internal mammary,IM)型、腋下-内乳(axillary-internal mammary,A-IM)型、锁骨上下(supraclavicular-subciavian,S)型、胸肌间(interpectoral,I)型、上腹(epigastrium type,E)型和其它;其中A型、A-IM型、IM型较为常见,在这三型中选取140例作为对比研究对象,均行经肋间隙入路的内乳区淋巴结(internal mammary lymph nodes,IMLN)探查、腋下淋巴结(axillary lymph nodes,ALN)探查或清扫、保乳或全乳切除,观察比较这三型淋巴结转移情况。结果:LDPT共450例:IM型25例占5.6%、A-IM型75例占16.7%、A型345例占76.7%、S型2例占0.4%、I型2例占0.4%、E型1例占0.2%、其它0例;其中A型、A-IM型、IM型共占98.9%,对比发现:A型、A-IM型、IM型这三型乳腺癌淋巴结转移情况不同,具有显著统计学差异(P<0.01);A型、A-IM型分别与IM型比较,淋巴结转移情况不同,具有统计学差异(P<0.017);IMLN和ALN均转移的概率A-IM型约是A型的5倍,单纯IMLN转移的概率A-IM型约是A型的26倍。结论:不同淋巴分型的乳腺癌淋巴转移规律不同,适合的诊治方法也可能不同,分型研究,具有临床意义;IM型乳腺癌淋巴转移与其他型不同,有其特有的规律,具有与A型同等重要的临床价值,值得关注。
Objective: To investigate the classification of lymphatic drainage in breast cancer foci and understand the differences of lymph node metastasis. To explore the various types of breast cancer lymph node metastasis and diagnosis and treatment of new ideas. Methods: From January 2006 to May 2016, patients with breast cancer cT_ (1-4) N_ (0-1) M_0 at Cancer Hospital of Kaifeng City were collected. Peri-tumor glands Injection of methylene blue followed by lymph node staining showed that lymph nodes or lymphatic vessels showed 450 lymph nodes during the operation. Breast was performed according to the direction of the lymphatic vessels stained and lymph nodes, especially the area of the sentinel lymph node (SLN) Lymphatic drainage pathway type (LDPT) is divided into axillary type A, internal mammary type IM, axillary-internal mammary type A -IM), supraclavicular-subciavian (S), interpectoral (I), epigastrium type (E) and others. Among them, A type, A-IM type and IM type are more common , Of which 140 cases were selected as the comparative study. All of them were examined by internal mammary lymph nodes (IMLN) through the intercostal space, axillary lymph nodes (ALN) probing or cleaning Breast or milk excision, observed and compared these three types of lymph node metastasis. Results: LDPT was performed in 450 cases: 25 cases of IM type accounted for 5.6%, 75 cases of A-IM type accounted for 16.7%, 345 cases of A type accounted for 76.7%, S type 2 cases accounted for 0.4%, I type 2 cases accounted for 0.4%, E 1 type accounted for 0.2%, the other 0 cases; type A, A-IM type, IM type accounted for 98.9%, the comparison found: type A, A-IM type, IM type three breast cancer lymph node metastasis, (P <0.01). There was significant difference between the type A and A-IM types and the type IM and the lymph node metastasis (P <0.017) About 5 times of A type, the probability of simple IMLN transfer A-IM type is about 26 times of A type. Conclusion: Lymphatic metastasis of breast cancer with different lymphomas is different, suitable diagnosis and treatment methods may also be different, the sub-type of study has clinical significance; lymphatic metastasis of IM breast cancer with different types, has its own unique laws, with A Equivalent important clinical value, it is worth attention.