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目的探讨对临床腋淋巴结阳性乳腺癌患者行改良根治术时采用改进L3淋巴结清扫方式的临床应用及意义。方法选择154例临床腋淋巴结阳性乳腺癌患者,临床分期Ⅱa期58例,Ⅱb期75例,Ⅲa期21例,采用改进的L3淋巴结清扫方式,对术后病理结果进行分析,同时随访观察患者的无病生存率。结果 154例患者中有腋淋巴结转移143例,占92.85%,有19例患者L3淋巴结转移,术前临床分期为Ⅱa期58例,L3淋巴结转移3例(5.17%),Ⅱb期75例,L3淋巴结转移10例(13.33%),Ⅲa期21例,L3淋巴结转移6例(28.57%),术前临床分期与L3淋巴结阳性病理结果呈正相关性(r=0.215,P=0.007),L3淋巴结未转移患者5年无病生存率为58.3%,L3淋巴结转移患者5年无病生存率为28.1%,2组差异有统计学意义。结论对临床腋淋巴结阳性乳腺癌患者行L3淋巴结清扫具有一定的临床应用价值,采用改进的淋巴结清扫方式,便于L3淋巴结的清扫。
Objective To investigate the clinical application and significance of modified L3 lymph node dissection in patients with clinical axillary lymph node positive breast cancer underwent modified radical mastectomy. Methods A total of 154 patients with clinical axillary lymph node positive breast cancer were enrolled in this study. There were 58 cases of stage Ⅱa, 75 cases of stage Ⅱb and 21 cases of stage Ⅲa. The pathological results were analyzed by improved L3 lymph node dissection. Disease-free survival. Results There were 143 cases of axillary lymph node metastasis (92.85%) in 154 cases, L3 lymph node metastasis in 19 cases, preoperative clinical stage was 58 cases of stage Ⅱ a, 3 cases of L3 lymph node metastasis (5.17%), 75 cases of stage Ⅱ b There were 10 cases (13.33%) of lymph node metastasis, 21 cases of stage Ⅲa and 6 cases of L3 lymph node metastasis (28.57%). There was a positive correlation between preoperative clinical stage and pathological results of L3 lymph node (r = 0.215, P = 0.007) The 5-year disease-free survival rate of patients with metastasis was 58.3%, and the 5-year disease-free survival rate of patients with L3 lymph node metastasis was 28.1%. The difference between the two groups was statistically significant. Conclusion The clinical application of L3 lymph node dissection in patients with axillary lymph node positive breast cancer is of clinical value. The improved lymph node dissection is adopted to facilitate the dissection of L3 lymph nodes.