乳腺癌腋窝清扫术中上肢淋巴结定位及转移规律的研究

 目的 在乳腺癌腋窝清扫术中利用上肢淋巴结反转定位ARM的技术对引流上肢的淋巴管及淋巴结进行定位，分析其转移可能性及对上肢淋巴水肿的影响。方法：选取乳腺癌改良根治术20例。美兰法进行术前定位。术中行淋巴结清扫，蓝染淋巴结单独分组，行免疫组化方法病理检测。结果：在20例患者中术中发现16例患者存在蓝染淋巴管及淋巴结，4例未发现蓝染的淋巴管或淋巴结。术中发现蓝染的上肢淋巴结均位于腋静脉下方，肋间臂神经上方这一区域内；在施行上肢淋巴结清除的患者中，术后短期内上肢水肿的发生率高于未进行上肢淋巴结清扫的患者；上肢淋巴结可能出现转移。结论 利用美兰法能够对腋窝处的上肢淋巴结进行定位；上肢淋巴结在腋窝的位置相对固定；肿瘤如仅在Level I 水平淋巴结发生转移，上肢淋巴结可能不会受累。

Study of Axillary Reverse Mapping and Lymph Node Metastasis during an Axillary Dissection

Objective In breast cancer axillary lymph node dissection,reverse positioning arm(ARM) technology is used for the upper limb lymphatic drainage and lymph nodes.This paper aimed to analyze the possibility of transfer and its impact on upper extremity lymphedema.Methods Twenty patients undergoing modified radical mastectomy were chosen whose axillary lymph nodes could be palpable or be found by breast ultrasound and enhanced CT examinations.All the patients did not receive preoperative neoadjuvant chemotherapy and neoadjuvant endocrine therapy.Methylene blue method was employed for preoperative localization.During operation,lymph node dissection was performed.Blue-stained lymph nodes were grouped and examined using the immunohistochemical method.Results Of the 20 patients,16 had blue-stained lymphatic vessels and lymph nodes,4 did not show blue-stained lymphatic vessels or lymph nodes.Blue-stained lymph nodes were found to have been located in the region below the axillary vein and over the Intercostal brachial nerves.The incidence of upper limb edema was higher in the patients with blue LN dissection than those without.Limb lymph node metastasis might occur.Conclusion Methylene blue method is feasible in axillary reverse mapping.The position of upper Limb lymph node in axillary is relatively stable.Limb lymph node would not be affected in only Level I lymph node metastasis.