腔镜腋窝淋巴结清扫在早期乳腺癌保乳手术中的应用

目的:探讨腔镜腋窝淋巴结清扫治疗早期乳腺癌保乳手术的可行性及临床效果。方法:回顾分析98例早期乳腺癌行保乳手术的临床资料,其中41例行腔镜腋窝淋巴结清扫术(腔镜组),57例行常规腋窝淋巴结清扫术(常规组),比较两组手术时间、出血量、清扫淋巴结个数、阳性淋巴结数及并发症、预后等。结果:两组均完成手术。腔镜组与常规组平均手术时间分别为99.5 min与61.5 min(P<0.05),平均清扫出腋窝淋巴结数分别为17.6枚与18.6枚(P>0.05),平均阳性淋巴结数分别为2.1枚与2.4枚(P>0.05),平均手术出血量分别为35.4 mL与61.5 mL(P<0.05)。随访1～4年,腔镜组无复发及转移病例,未出现术后并发症。常规组1例出现患侧上肢水肿,1例乳房皮肤瘢痕愈合不良;1例乳房局部复发,1例肺转移,1例胫骨转移。两组均无死亡病例。结论:腔镜腋窝淋巴结清扫术与开放腋窝淋巴结清扫术同样能彻底完成腋窝淋巴结清扫,具有并发症少,美学效果好的优势。     

不做脂肪溶解的腔镜腋窝淋巴结清扫术

目的探讨采用气囊扩张方法形成手术操作空间，进行腔镜下腋窝淋巴结清扫术的可行性。方法2005年6～10月，对7例乳腺癌应用术前乳晕或肿块周围亚甲蓝注射与腋窝置入气囊相结合的方法，形成腔镜操作空间，指引腔镜下腋窝淋巴结清扫。结果每例清扫腋窝淋巴结9～17枚，平均12．3枚，未见到破碎淋巴结，4例检出阳性淋巴结。腋窝淋巴结清扫手术时间95～140min，平均114．3min。腋静脉等腋窝重要解剖结构显示清晰。无上肢水肿及其他腋窝手术区并发症。7例随访2～64个月，平均4．6月，未见复发。结论采用气囊扩张方法形成的手术操作空间可以实施腔镜下腋窝淋巴结清扫术。     

吸脂法腔镜腋窝淋巴结清扫手术的技术探讨

目的探讨吸脂法腔镜腋窝淋巴结清扫的手术技术.方法分析采用吸脂法进行完全腔镜腋窝淋巴结清扫手术的45例患者的临床资料,并与传统开放手术进行比较.结果完全腔镜腋窝淋巴结清扫手术组清扫淋巴结8～34枚,平均18枚;腔镜腋窝淋巴结清扫手术时间为60～190min,平均108 min,较传统手术时间长（P＜0.05）.腔镜手术组出血量为80～220 ml,平均152.82 ml,明显少于常规手术组280.29 ml（P＜0.01）.腔镜手术组术后腋窝引流量为60～180 ml,平均140.38ml,拔引流管时间6～15 d,平均6.91 d.术后皮下积液7例,皮肤表皮水疱5例,胸壁和上臂内侧蜂窝织炎2例.腔镜手术组在清扫腋窝淋巴结数目、术后引流量、引流时间、术后并发症等方面与常规开放性手术相比较无明显差异（P＞0.05）.结论腔镜手术组手术切口相对较小,美容效果较好,患者比较满意.吸脂法腔镜腋窝淋巴结清扫可以达到常规手术的清扫范围,但技术有待进一步规范.     

早期乳腺癌腔镜腋窝淋巴结清扫术效果分析

目的:探讨早期乳腺癌腔镜下腋窝淋巴结清扫术的临床效果。方法:回顾性分析2010年2月—2012年10月我院头颈乳腺科收治的Ⅰ期、Ⅱ期乳腺癌患者110例,按淋巴结清扫方式不同分为腔镜下手术腋窝淋巴结清扫组(实验组)50例和传统手术腋窝淋巴结清扫组(对照组)60例。比较两组患者手术时间、术中出血量、淋巴结清扫枚数、术后引流量、并发症发生率、预后等。结果:实验组和对照组平均手术时间分别为(115.12±23.45)min、(78.42±18.34)min,平均术中出血量分别为(48.36±10.35)m L、(87.42±20.76)m L,平均术后引流量分别为(195.62±47.87)m L(362.72、±67.93)m L,差异均有统计学意义(P0.05);实验组和对照组平均淋巴结清扫枚数分别为(16.92±4.37)枚、(18.83±4.98)枚,差异无统计学意义(P0.05);实验组和对照组术后并发症发生率分别为5%和16.67%,差异有统计学意义(P0.05)。术后所有患者均获随访4~37个月,平均随访(22.21±14.67)个月。实验组和对照组术后复发转移分别为3例和4例,两组复发转移率比较差异无统计学意义(P0.05)。结论:早期乳腺癌腔镜下腋窝淋巴结清扫与传统手术清扫的临床效果无明显差异,但腔镜具有微创优势。     

32例腔镜下乳腺癌腋窝淋巴结清扫术临床分析

目的 探讨腔镜下乳腺癌腋窝淋巴结清扫手术方法、可行性及临床效果.方法 回顾性分析32例乳腺癌腔镜下腋窝淋巴结清扫手术(腔镜组)的临床资料,并与46例同期临床分期类似而行传统腋窝淋巴结清扫(传统组)资料比较.结果 两组均为Ⅰ～Ⅱ期乳腺癌.腔镜组无中转开放手术,未发生大出血、皮下气肿、脂肪栓塞等并发症.腔镜组淋巴结数目(15.5枚)、平均手术时间(80min)与传统组比较差异均无统计学意义.但缩短了引流时间(3～5d)、减少了出血量(380ml)和术后并发症发生率(仅1例).结论 在选择性乳腺癌患者行腔镜下腋窝淋巴结清扫术能够达到传统腋窝淋巴清扫治疗效果,可在保证腋窝淋巴结清扫质量的同时降低手术并发症发生率,达到了生理、心理的微创化,提高了患者的生活质量.腔镜下腋窝淋巴结清扫术是可行的.     

乳腔镜腋窝淋巴结清扫的手术技术

目的 探讨乳腔镜腋窝淋巴结清扫的手术技术。方法 分析473例次乳腔镜腋窝淋巴结清扫手术的临床效果及手术经验。结果 本组患者手术时间22—156min,平均42min。术中出血很少,无一例因术中不易控制的大量出血而中转常规开放手术。各例患者取出淋巴结4—38个,平均14个。所有病例术中、术后均未出现任何手术并发症。结论 乳腔镜腋窝淋巴结清扫特殊的手术视野使手术解剖清晰。遵循恰当的手术经路、手术方式标准化会绕过乳腔镜腋窝淋巴结清扫手术的学习曲线,加快手术速度,避免并发症的发生。     

腔镜在早期乳腺癌腋窝淋巴结清扫中的应用价值：附21例报告

目的 探讨应用腔镜行早期乳腺癌腋窝淋巴结清扫术(E-ALND)的价值.方法 收集近2年内采用吸脂法进行腔镜下腋窝淋巴结清扫手术的21例早期乳腺癌患者的临床资料,并与同期传统手术进行比较.结果 21例E-ALND手术中无1例中转开放手术.与传统手术相比,腔镜腋窝淋巴结清扫术清除淋巴结的数量无明显差异[(18.26±4.62)枚 vs.(17.15±3.83)枚];手术时间明显延长[(82.21±28.12)min vs.(138.42±36.06) min];腋窝出血量显著减少[(192.16±60.27)mL vs.(115.31±32.18 )mL];拔除腋窝引流管时间明显缩短[(10.1 ±3.2)d vs.(6.8±2.8)d].3个月的随访结果显示,与传统手术相比,腔镜组上肢感觉异常发生率明显减少(32.2% vs.4.78%),但上肢疼痛、水肿发生率无明显差异.腔镜组术后出现局部皮肤水疱2例,胸壁蜂窝组织炎1例,皮下积液2例,均治愈.随访2~21个月,未见trocar处种植转移.结论 腔镜行早期乳腺癌腋窝淋巴结清扫术具有切口小、隐蔽,术后恢复快,并发症少,且符合美学要求,较传统的腋窝淋巴结清扫术有明显的微创优势,具有较好的应用前景.     

乳腔镜腋窝淋巴结清扫术21例临床分析

目的:探讨乳腺癌腔镜腋窝淋巴结清扫术的疗效及操作技巧。方法:回顾分析2011年5月至2012年7月为21例乳腺癌患者行腔镜腋窝淋巴结清扫术的临床资料。结果:20例顺利完成手术,1例因腋窝溶脂欠佳中转开放手术。手术时间60～184 min,平均(91±21)min;术中出血量15～50 ml,平均(35.2±13.1)ml。术中损伤肋间臂神经2例,发生皮下气肿2例。结论:乳腔镜腋窝淋巴结清扫术具有微创、并发症少、美观等优势,值得推广,但术者需具备一定的手术技巧。     

乳腔镜腋窝淋巴结清扫术的应用

目的 探讨乳腔镜腋窝淋巴结清扫术的治疗效果及操作技巧.方法 回顾分析2008年12月以来50例腔镜腋窝淋巴结清扫术和50例传统腋窝淋巴结清扫手术乳腺癌患者的临床资料.分别比较两组平均手术时间、出血量、清扫淋巴结数目、淋巴结转移数、住院时间及术后并发症的发生率.结果 两组平均清扫淋巴结数目、淋巴结转移数、住院时间差异无统计学意义(P>0.05).腔镜组平均手术时间为(221.85±19.61)min,较常规手术组时间显著延长(P=0.000),但术中出血量少(P=0.012),术后并发症发生率低(P=0.034).结论 乳腔镜腋窝淋巴结清扫术具有创伤小、操作简单、并发症少、术后恢复快、瘢痕小等优点,是一种值得推广的手术方法,但腔镜操作延长了手术时间,其手术技巧有待进一步提高.     

无充气经腋窝后入路腔镜甲状腺微灶癌手术47例北大核心CSCD

目的探讨无充气经腋窝后入路腔镜甲状腺微灶癌手术的安全性。方法2020年1月~2022年2月我院对47例甲状腺微灶癌行无充气经腋窝后入路腔镜甲状腺单侧腺叶和峡部切除联合中央区淋巴结清扫术。结果47例手术均顺利完成,无中转开放手术。手术时间65~145 min,(101.5±20.3)min。术中出血量5~40 ml,中位数15 ml。住院时间3~9 d,(6.0±1.4)d。术后病理:微灶乳头状癌;淋巴结清扫2~11枚,(4.7±1.9)枚。术后无严重并发生发生。术后美容满意程度评分表(9.2±0.7)分,满意度较高。47例术后随访2~26个月,平均12.2月,均未见肿瘤复发及颈部淋巴结转移。结论无充气经腋窝后入路腔镜甲状腺微灶癌手术安全可行,能很好地全程暴露喉返神经及保护甲状旁腺,美容满意度高。     

Experience with endoscopic axillary lymphadenectomy using needlescopic instruments in patients with breast cancer

BACKGROUND: The purpose of this study was to evaluate the safety and efficacy of endoscopic axillary lymphadenectomy using needlescopic instruments in patients with breast cancer. METHODS: Five patients with breast cancer were treated by partial mastectomy and endoscopic axillary lymphadenectomy. We evaluated the results of the surgical procedure and the postoperative course. RESULTS: In all the patients, endoscopic axillary lymphadenectomy was performed successfully. The mean duration of the operation was 105.4 min, the mean blood loss 19.4 ml, and the mean number of dissected axillary lymph nodes 13. There were no intra- or postoperative complications. The mean amount of lymphorrhea was 131.2 ml, and the mean duration of drainage was 3.6 days. No postoperative analgesics were administered. CONCLUSIONS: Endoscopic axillary lymphadenectomy can be performed safely with needlescopic instruments, but further study is needed to establish this technique.     

Breast Cancer in Identical Twins with Different Clinical Course

Abstract: Recent discussions have questioned the need or benefit of radical axillary lymphadenectomy for some patients as part of treatment for breast carcinoma. An evaluation of the need for discontinuous lymphadenectomy is presented with proposal to eliminate lymphadenectomy in the breast-conserving therapy of some patients.
From 1977 through 1993, 101 breasts in 95 patients with breast carcinoma were treated by breast conservation without radical axillary lymphadenectomy.
At median follow-up of 76 months, only four patients (4.0% of cancers) had occurrence of axillary disease requiring invasive evaluation of delayed clinically positive axillae. One of the four patients had negative nodes. Two patients had positive lymph nodes without recurrent disease in the ipsilateral breast or distant metastasis. The fourth patient had distant metastasis, and a positive fine-needle aspiration biopsy of an axillary lymph node was sufficient for diagnosis. Discontinuous radical axillary lymphadenectomy was neither technically different nor more difficult that primary lymphadenectomy.
Some breast cancer patients may forego surgical evaluation of the axilla as part of their breast conservation therapy without compromise in adjuvant therapy decisions or detriment in outcome. The authors strongly recommend large prospective, clinical studies be performed in the near future.     

Surgical axilla dissection. Technical standard or obsolete method?

Axillary lymph node status remains the single most important prognostic parameter and has crucial therapeutic implications in patients with breast carcinoma. Surgical dissection of the axilla is commonly regarded as the standard procedure of axillary staging, its sensitivity and specificity being 99% and 100%, respectively. Apart from giving reliable information on the individual prognosis axillary dissection also contributes to efficient local tumor control in the axilla, as it reduces the risk of local recurrence to less than 1.4% if more than 10 lymph nodes are removed. Alternative, less or non-invasive axillary staging methods have either not yet been sufficiently standardized (immunoscintigraphy, PET-scan, prediction of axillary lymph node status by means of individual risk factors) or are associated with a considerable risk of false-negative staging (up to 50% of patients with positive axillary lymph nodes are not detected by palpation alone, ultrasonography or CT-scan). The basic principles of axillary sampling and axilloscopic dissection are questionable because the number of lymph nodes removed during these procedures is commonly less than 10. With its sensitivity/specificity being comparable to that of standard axillary dissection sentinel lymph node biopsy represents a highly promising approach which will in the future potentially lead to significant optimization of the clinical management of patients with breast cancer, especially those diagnosed in early stages (T1 a, T1 b and T1 c).     

前哨淋巴结活检在乳腺癌中的临床应用

目的 探讨术中前哨淋巴结（sentinel lymph node,SLN）定位和活检（SLNB）对预测乳腺癌腋窝淋巴结（axillary lymph node,ALN）转移的准确性.方法 对48例乳腺癌患者术前10min用亚甲蓝注射液4ml注射到肿瘤周围或活检腔的正常乳腺组织,进行SLN定位和活检,然后行乳腺癌改良根治术.结果 SLNB的检出成功率为95.8%,准确率为97.8%,假阴性率3.0%,假阳性率为0.结论 用亚甲蓝作SLN定位进行SLNB能准确预测乳腺癌ALN转移状态.     

Endoscopic axillary lymphadenectomy without prior liposuction

Background: A new technique of endoscopic axillary lymphadenectomy without prior liposuction was developed by our group. Method: A total of 33 patients with early stage breast cancer were treated by breast-conserving therapy and endoscopic axillary lymphadenectomy. Results: The median duration of the operation was 74.9 min (range, 30–130). Operation time was significantly shorter for the last 17 patients (p < 0.05) than for the first 16 patients. There were no intraoperative complications. The median number of removed lymph nodes was 14.5 (range, 2–28). Postoperatively three patients developed a seroma, one of which required evacuation. At postoperative day 5, arm mobility was unrestricted in 26 patients (78.7%); nine patients (27.2%) reported a loss of sensation in the outer side of the upper arm related to dermatome C5. One patient developed a temporary alar scapula, and one patient developed an axillary abscess 9 weeks after axillary lymphadenectomy during radiation therapy. After a median follow-up of 4.6 months seven patients reported persistent impairment of sensation, but all patients had regained full shoulder mobility. Conclusion: Endoscopic axillary lymphadenectomy can be done safely without prior liposuction. Received: 28 May 1998/Accepted: 2 September 1998     

Clinical feasibility and surgical benefits of video-assisted mediastinoscopic lymphadenectomy in the treatment of resectable lung cancer

Objective: This study was performed to assess the clinical feasibility and surgical outcomes of video-assisted mediastinoscopic lymphadenectomy in the treatment of resectable lung cancer. Methods: Between July 2004 and December 2009, we retrospectively analyzed 108 consecutive video-assisted mediastinoscopic lymphadenectomies in lung cancer patients from a prospectively collected database. Ninety-seven (89.8%) patients underwent combined operation during the same anesthesia and six (5.3%) patients underwent a staged operation for the resection of lung cancer and systematic lymphadenectomy. We reviewed the indication and duration of video-assisted mediastinoscopic lymphadenectomy, its complication, combined or staged operation type, the number of dissected lymph nodes and nodal stations, and pathologic staging of the mediastinal node. Results: Mean operative time of video-assisted mediastinoscopic lymphadenectomy was 39.8 ± 12.3 min (range of 14–85 min). Mean number of resected lymph nodes was 16.0 ± 7.7 (range of 3–37). In video-assisted mediastinoscopic lymphadenectomy, the rates of lymph node dissection of stations 4R, 4L, and 7 were 71.3%, 88.0%, and 100%, respectively, whereas the rates of dissection of lymph nodes in station 2R and 2L were only 22.2% and 17.6%, respectively. There was no operative mortality. We identified five complications of recurrent nerve palsy. Conclusions: Video-assisted mediastinoscopic lymphadenectomy is a clinically feasible procedure with acceptable complication rate and provides more accurate staging of mediastinal node in lung cancer patients. It may be also an excellent supplementary technique used for complete mediastinal node dissection at minimal invasive surgery for cancer resection, especially with left-sided video-assisted thoracoscopic lobectomy.     

Axillary lymphectomy in breast cancer

BACKGROUND: The aim of the study was to demonstrate the prognostic value of sentinel node biopsy compared to the sampling of clinically suspected nodes and lymphectomy of the 3 axillary levels. METHODS. From October 1996 to January 1999, 60 patients with breast cancer with a diameter of 4 cm or under using different procedures of axillary lymphadenectomy. Sentinel node biopsy was performed using Giuliano's technique, followed by lymph nodes larger than 5 cm (lymph node sampling) and lastly all axillary lymph nodes (axillary lymphectomy at 3 levels). RESULTS: Sentinel nodes were identified in all patients and a mean of 3 sentinel nodes (range 1-5) were removed during the procedure. Histological analysis showed metastatic sentinel nodes in 21 cases. Lymph node sampling was possible in 43 patients who presented enlarged nodes. The mean number of lymph nodes removed was 6 (range 3-10). Lymph node metastasis was found in 10 patients and of these 7 had a metastatic sentinel node, whereas 3 had presented negative results. Histological tests in all 60 cases of complete axillary lymphectomy showed positive results in 4 cases confirming metastasis present in sentinel nodes. CONCLUSIONS: The results show that the association of lymph node sampling can improve the efficacy of sentinel node dissection, highlighting the rare cases of false negatives. In our study, total axillary lymphectomy did not add any information to the N parameter and was resolutive in a small percentage of cases.     

Improved axillary staging of breast cancer with sentinel lymphadenectomy.

OBJECTIVE: The authors evaluated the effect of intraoperative lymphatic mapping and sentinel lymphadenectomy (SLND) on the axillary staging of patients with carcinoma of the breast. SUMMARY BACKGROUND DATA: The accurate staging of patients with breast cancer is essential to guide management and determine prognosis. The authors previously reported the feasibility and accuracy of SLND in breast carcinoma. Sentinel lymphadenectomy identifies the first ("sentinel") axillary lymph node draining the site of a primary tumor; because this node is the most likely site of axillary metastasis, histopathologic examination of the sentinel node correlates well with examination of the entire axillary contents. The current study compares SLND with standard axillary lymphadenectomy (ALND) for the staging of breast carcinoma. METHODS: The incidence of axillary node metastasis and micrometastasis in SLND and ALND specimens from patients undergoing operative treatment of a primary breast carcinoma was compared prospectively. Multiple sections of each sentinel lymph node in SLND specimens were examined by hematoxylin and eosin (H&E) staining and by immunohistochemical techniques using antibodies to cytokeratin. One or two sections of each nonsentinel lymph node in ALND specimens were examined by routine H&E staining. RESULTS: One hundred thirty-four patients underwent ALND (ALND group), and 162 underwent successful SLND followed by completion ALND (SLND group). Both groups were similar with respect to age (median, 55 and 54 years, respectively), palpable primary tumors (54.5% and 59.3%, respectively), palpable axillary nodes (5.2% and 7.4%, respectively), size of primary tumor (median, 1.5 cm in each group), and total number of axillary lymph nodes examined (median, 19 and 21, respectively). The number of patients with axillary metastasis was 39 (29.1%) in the ALND group and 68 (42.0%) in the SLND group (p < 0.03). Of these, 4 of 39 (10.3%) ALND patients (3.0% of all ALND patients) and 26 of 68 (38.2%) SLND patients (16.0% of all SLND patients) had micrometastasis (< or = 2 mm), a highly significant difference (p < 0.0005) CONCLUSIONS: Sentinel lymphadenectomy with multiple sectioning and immunohistochemical staining of sentinel nodes increases the accuracy of axillary staging in breast cancer and can identify significantly more patients with lymph nodes metastases, especially micrometastases, than can ALND with routine histopathologic processing of lymph nodes.     

Axillary Lymph Node Echo-Guided Fine-Needle Aspiration Cytology Enables Breast Cancer Patients to Avoid a Sentinel Lymph Node Biopsy. Preliminary Experience and a Review of the Literature

Purpose For many years, the status of the axillary lymph nodes has been determined by an axillary lymphadenectomy. However, a sentinel lymph node biopsy has been shown to effectively replace the need for an axillary lymphadenectomy in order to determine the axillary staging. This study presents the preliminary results regarding the efficacy of fine-needle aspiration cytology (FNAC) to identify metastatic axillary lymph nodes in the pre-operative phase. Methods One hundred lymph nodes from 100 patients with histologically and cytologically confirmed breast cancer (cT1–2 cN0) underwent echo-guided FNAC. The diagnostic accuracy (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV]) for the axillary metastases was evaluated based on the histological findings of either a sentinel lymph node biopsy or an axillary lymphadenectomy as a reference standard. Results It was possible to avoid a sentinel lymph node biopsy in 30% of the cases; the sensitivity was 68%, specificity 100%, PPV 100%, and NPV 65%. Echo-guided FNAC of the axillary lymph nodes should thus be included among the regular diagnostic procedures of presurgical staging. Conclusion This simple, inexpensive, and minimally invasive technique makes it possible to avoid the additional cost of a sentinel lymph node biopsy while also sparing the patient the stress of undergoing a second surgery.