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目的探讨乳腺癌新辅助化疗前利用腔镜前哨淋巴结活检术评估腋窝淋巴结状态的临床效果。方法对2014年1月至2015年1月因拟行乳腺癌新辅助化疗而行前哨淋巴结活检术的59例患者资料进行分析,其中以腔镜方法完成者27例,行传统开放手术者32例。对两种术式的淋巴结检出率、检出数目、术后美容效果评分和术后并发症进行比较。结果腔镜组前哨淋巴结检出率(100%)高于开放组(96.88%),但差异无统计学意义(P=0.246)。腔镜组前哨淋巴结平均检出数为4.59±0.84个,显著高于开放组的2.19±1.04个,差异有统计学意义(P<0.001)。两组均无腋窝局部复发病例。腔镜组对手术美容效果感觉“非常满意”者比率(100%)明显高于开放组(53.13%),差异有统计学意义(P<0.001)。术后并发症:腔镜组术后上肢感觉异常发生率(3.70%)明显低于开放组(12.50%),差异有统计学意义(P=0.040)。腔镜组平均手术时间(49.78±7.32 min)长于开放组(31.53±6.09 min),差异有统计学意义(P<0.001)。结论乳腺癌新辅助化疗前利用腔镜进行前哨淋巴结活检,与传统开放手术相比,前者淋巴结检出率更高,同时可以更完整的保留上肢感觉和更好的保持美观的外形。
Objective To investigate the clinical effect of using axillary lymph node biopsy to evaluate axillary lymph node status before neoadjuvant chemotherapy in breast cancer. Methods From January 2014 to January 2015, 59 patients with sentinel lymph node biopsy undergoing neoadjuvant chemotherapy for breast cancer were analyzed. Among them, 27 were completed by endoscopic approach, 32 were underwent traditional open surgery . Lymph node detection rate, the number of detection, postoperative cosmetic effect score and postoperative complications were compared. Results The detection rate of sentinel lymph node in endoscopic group (100%) was higher than that in open group (96.88%), but the difference was not statistically significant (P = 0.246). The average number of sentinel lymph nodes in the endoscopic group was 4.59 ± 0.84, which was significantly higher than that of the open group (2.19 ± 1.04) (P <0.001). No cases of axillary local recurrence in both groups. The ratio of lumpectomy group to the aesthetic feeling of operation was 100%, which was significantly higher than that of the open group (53.13%). The difference was statistically significant (P <0.001). Postoperative complications: The incidence of postoperative upper limb sensory abnormalities (3.70%) in the endoscopic group was significantly lower than that in the open group (12.50%), with a significant difference (P = 0.040). The average operation time of endoscopic group (49.78 ± 7.32 min) was longer than that of open group (31.53 ± 6.09 min), the difference was statistically significant (P <0.001). Conclusions Sentinel lymph node biopsy with endoscopy before neoadjuvant chemotherapy for breast cancer, compared with the traditional open surgery, the former has a higher detection rate of lymph node, and can more completely retain the upper limb feel and better maintain the appearance of beauty.