腔镜腋窝淋巴结清扫在早期乳腺癌保乳术中的应用

目的探讨乳腔镜腋窝淋巴结清扫治疗早期乳腺癌保乳术中的可行性及有效性。方法将118例早期乳腺癌分为对照组和腔镜组。对照组65例，采用乳腺单纯切除加腋窝淋巴结清扫；腔镜组53例，采用小切口乳腺局部切除后，行腔镜腋窝淋巴结清扫。结果所有手术均获成功。腔镜组与对照组手术时间分别为（68±12）min与（72±17）min（P〉0．05）、术中出血量分别为（35．8±5．9）ml与（300±58）ml（P〈0．05）、平均每例取出淋巴结分别为（19±3．5）枚与（18±3．0）枚（P〉0．05）、术后平均住院时间分别为（7．5±3．2）d与（12．3±4．7）d（P〈0．05）。腔镜组2例（3．8％）出现皮下积液而无皮肤坏死，对照组10例（15．3％）出现皮下积液及5例（7．7％）出现皮肤坏死裂开，两组差异有统计学意义（P〈0．05）。腔镜组肩关节活动均良好，对照组8例活动受限。本组均获随访，随访时间36～72个月，平均45．9个月，腔镜组无局部复发，远处转移2例（3．7％），死亡1例（1．9％）；对照组1例腋窝淋巴结复发，远处转移2例（3．0％），死亡1例（1．5％）。两组术后局部复发率、远处转移率与死亡率差异无统计学意义（P〉0．05）。结论腔镜腋窝淋巴结清扫在早期乳腺癌保乳术中，有一定的可行性及有效性，术后恢复较快。

The application of mastecoscope to dissect axillary lymph node in breast-conserving surgery

Objective To explore the feasibility and efficacy of axillary lymph node dissection through mastoscope in breast conserving surgery. Methods 118 patients with breast cancer admitted in our hospital from March, 2002 to January, 2006 were divided into control and mastecopic group. 65 patients in control group were treated with entirely mastectomy and axillary lymph node dissection and 53 patients of mastocopic group were treated with breast-conserving surgery and mastecoscopic axillary lymph node dissection. Results All the operations were successful. The mean operative duration of mastecoscopic group and control group was 68±12min and 72±17min (P＞0.05). The mean blood loss were 35.8±5.9ml and 300±58ml (P<0.05). The average number of lymph nodes removed were 19±3.5 and 18±3.0 (P＞0.05) and the average number of days in hospital were 7.5±3.2 and 12.3±4.7 days (P<0.05). In mastecoscopic group there was 1 patient had subcutaneous hydrops and no skin necrosis, but 10 patients in the control group had cutaneous hydrops and 5 patients skin necrosis. Recurrence, metastasis and death was 0% (0/53), 3.7% (2/53) and 1.8% (1/53) in mastecoscopic group, and 1.5% (1/65), 3.0% (2/65) and 1.5% (1/65) in the control group (P＞0.05). Conclusions It is safe and feasible to perform the mastoscopic axillary lymph node dissection in breast conserving surgery in the patient with early stage breast cancer.