腋窝淋巴结清扫术治疗前哨淋巴结活检阴性乳腺癌的系统评价

目的系统评价腋窝淋巴结清扫术治疗前哨淋巴结活检阴性乳腺癌的有效性和安全性。方法检索CNKI、PubMed、EMBASE、CBM从建库至2013年12月1日的文献资料,选择腋窝淋巴结清扫术和前哨淋巴结活检术治疗乳腺癌患者的试验,严格按照制订纳入和排除标准对纳入的研究进行筛选、资料提取、质量评价和结果分析。使用Revman 5.1软件,进行统计学分析(Meta-分析)。结果最终纳入10篇文献,患者共7731例。因纳入文献在研究类型、测量指标、随访时间以及统计学指标的差异较大,采用亚组分析,Meta分析同质研究,其余采用定性的描述性分析。本研究结果显示,在无病生存率、总体生存率、局部复发率、远处转移率方面,不同随访时间腋窝淋巴结清扫术与前哨淋巴结切除术间差异均无统计学意义。结论对于单发浸润性乳腺癌患者前哨淋巴结活检呈阴性时,可不必行腋窝淋巴结清扫术。目前尚需相关高质量随机对照试验和长期的随访进一步证实此系统评价的结论。     

应用超声刀行乳腺癌腋窝淋巴结清扫近期疗效观察

目的 研究应用超声刀行乳腺癌腋窝淋巴结清扫的安全性及近期疗效。方法 回顾性分析2009年9月至2010年12月,北京大学第一医院乳腺疾病中心应用HARMONIC超声刀配备FOCUS刀头行乳腺癌腋窝淋巴结清扫手术30例的临床资料（研究组）,并选择同期、相同术者完成的以高频单极电刀行腋窝淋巴清扫手术病例为对照组,进行对比观察。结果 研究组的平均腋窝引流时间短于对照组（11.4 vs. 15.7d,P=0.029）,而手术时间、术中出血、淋巴结清扫数量以及淋巴引流总量等方面二者差异无统计学意义。结论 与高频单极电刀相比,应用超声刀行乳腺癌腋窝淋巴结清扫安全可靠并可以缩短术后腋窝引流时间及住院天数。     

乳腺癌分子分型与腋窝淋巴结外科处理

目的探讨乳腺癌分子分型是否影响腋窝淋巴结的术式选择。方法检索有关乳腺癌分子分型与腋窝淋巴结转移情况的文献并进行综述。结果三阴型乳腺癌患者的前哨淋巴结与非前哨淋巴结阳性率均较低,luminalB型和HER-2过表达型患者的腋窝淋巴结转移率较高,尤其是luminalB型乳腺癌患者,其前哨淋巴结阳性率、非前哨淋巴结阳性率均较其他分子分型高,对于行保乳手术的老年患者,当仅有1～2枚前哨淋巴结转移时,可免行腋窝淋巴结清扫;对于肿瘤体积较大的年轻患者,即使前哨淋巴结阴性,非前哨淋巴结阳性的可能性仍然较大,行腋窝淋巴结清扫可能会使这部分患者受益。结论对于腋窝淋巴结的术式选择,乳腺癌分子分型也是需要考虑的因素之一。     

乳腺癌前哨淋巴结活检研究进展

在乳腺癌的外科治疗中，不论是改良根治还是保留乳房治疗，都要常规进行腋窝淋巴结清扫，以获得肿瘤分期资料从而指导下一步治疗，但腋窝淋巴结清扫会带来许多并发症，如上肢水肿和功能障碍、皮下积液、刀口愈合不良等，为了避免这些并发症，又能进行准确的分期，前哨淋巴结(setinel lymph node，SLN)活检技术应运而生，它具有操作简     

前哨淋巴结活检术替代腋窝淋巴结清扫术在乳腺癌中的临床应用

目的探讨前哨淋巴结活检术（SLNB）替代腋窝淋巴结清扫术（ALND）在早期乳腺癌患者中的应用价值和安全性。方法对2003年1月到2005年12月期间行前哨淋巴结活检术替代腋窝清扫术的125例患者作为研究组,对同一时期行腋窝清扫术且术后病理淋巴结阳性个数≤1的45例患者作为对照组;比较两组患者术后上肢并发症的发生情况及腋窝复发情况。结果SLNB替代ALND术后上肢麻木、肿胀、疼痛、僵硬、上肢活动受限及肌力减退方面的并发症均明显较ALND少,在随访36．5个月中,仅出现一例腋窝复发。结论前哨淋巴结活检术替代腋窝淋巴结清扫术术后并发症明显减少,腋窝复发率低,是早期乳腺癌患者的安全分期手术。     

乳腺癌前哨淋巴结的病理检测

乳腺癌是全世界女性发病率最高的恶性肿瘤.腋窝淋巴结转移是乳腺癌最重要的预后指标[1].传统的腋窝淋巴结清扫术(axillary lymph node dissection,ALND)虽然对乳腺癌患者有治疗和预测预后的作用,但其副作用也是相当明显的.它可以导致乳腺癌患者出现患侧上肢水肿、疼痛、手臂运动功能障碍以及淋巴血管肉瘤等并发症,严重影响其生活质量[2-4].     

乳腺癌腋窝淋巴结清扫术中保留上肢淋巴结的可行性研究

目的 探讨乳腺癌腋窝淋巴结清扫术(ALND)中保留上肢淋巴结的可行性.方法 52例早期乳腺癌在施行ALND前于患侧前臂皮下注射亚甲蓝5 ml进行上肢淋巴结定位,术中分检出上肢淋巴结和水平Ⅱ淋巴结,水平Ⅱ淋巴结进行印片细胞学和冰冻切片病检.术后所有淋巴结分组进行常规病检.结果 52例术中可见上肢淋巴结蓝染50例(96.2...     

乳腺癌腔镜腋窝淋巴结清扫策略及价值

乳腺癌腔镜腋窝淋巴结清扫（MALND）特殊的手术视野可清晰暴露腋窝解剖结构，最大限度地避免对腋窝血管、淋巴管和神经的损伤，最大程度减少了常规腋窝淋巴结清扫手术后并发症的发生，达到了微创、保留功能和美观的效果。MALND不同于常规腔镜手术，完成该手术的前提条件是术者应较熟练掌握腔镜技术，同时也须熟悉腋窝区的解剖结构。手术流程遵循“自下而上、从低到高”的“时间顺序”和“空间顺序”，即先从腋窝底部往上，至腋窝中部，最后再到腋窝顶部。MALND改变了传统乳腺癌手术程序和路径、手术方法和技术、以及手术视野角度，并且放大了腋窝内局部视野，降低了手术难度。     

Women's choice between sentinel lymph node biopsy and axillary clearance

Purpose : To determine whether women would choose sentinel lymph node biopsy (SLNB) or axillary clearance (AC) for breast cancer treatment when they are given a single choice based on clear information about morbidity and mortality. Methods : The expected 5‐year survival rate of women with breast cancer after either SLNB or AC was calculated using a utility analysis of established literature. The difference in survival was one in 1000. This and other detailed information on SLNB and AC was presented in a questionnaire, which provided subjects with a scenario and a choice between SLNB and AC. After a pilot study of 40 subjects, the questionnaire was mailed to 400 women (who had no mammographic abnormality) attending Breast Screen and handed to 100 women (who were over 40 years of age and had breast symptoms but not cancer) attending the rooms of two surgical specialists. Results : One hundred and twenty one of the 243 respondents to the mailed questionnaires (49.8%) chose SLNB and 35% of the 100 consulting room subjects chose SLNB rather than AC. Conclusions : Women faced with the possibility of having breast cancer seem to be very conservative in their choice of treatment, many choosing the increased morbidity of AC rather than the very small (one in 1000) increased risk of death at 5 years from SLNB. This raises questions about proposals to offer SLNB as standard treatment and demands that women are fully informed about any increased risk of death when making their choice between SLNB and AC. Abbreviations: AC, axillary clearance; SLNB, sentinel lymph node biopsy.     

Clinical practice guidelines for the use of axillary sentinel lymph node biopsy in carcinoma of the breast: current update

Axillary sentinel lymph node biopsy (SLNB) has been adopted as a suitable alternative to traditional level I and II axillary dissection in the management of clinically node-negative (N0) breast cancers. There are two current techniques used to identify the sentinel node(s): radiopharmaceutical, technetium sulfur colloid, and isosulfan blue dye (used in the United States) and technetium-labeled albumin and patent blue dye (used in Europe). (The labeled albumin is not U.S. Food and Drug Administration [FDA] approved in the United States.) SLNB to replace axillary dissection should only be performed by surgeons and patient management teams with appropriate training and experience. Although both radiocolloid and blue dye are used together by most surgeons, and training should be in both techniques, some experienced surgeons use one or the other almost exclusively. In addition, surgical pathologists must recognize the need to examine these small specimens with great care, using a generally adopted protocol. Imprint cytology or frozen sections may be used, followed by additional sections for light microscopy. Immunochemical staining with cytokeratin or other techniques to identify "submicroscopic" metastasis is often used, but the results should not be used to influence clinical decisions with respect to adjuvant therapy. "Failed" SLNB implies the surgeon's failure to identify the sentinel nodes, in which case a complete dissection is performed. A "false-negative" SLNB implies the finding of metastasis in the excised sentinel nodes by light microscopy after a negative frozen section examination. Whether a false-negative SLNB mandates completion axillary dissection is controversial, with clinical trials currently under way to answer this question. Although SLNB was initiated to accompany breast-conserving treatment, it is equally useful in patients undergoing mastectomy. It is more difficult to perform with mastectomy. When using blue dye only, SLNB may require a separate incision because of time constraints between injection and identification of the blue-stained nodes; radiocolloid usually does not. Completion axillary dissection after false-negative SLNB is more difficult after mastectomy. SLNB is a useful procedure that may save 70% of women with clinically negative (N0) axillae and all of those with pathologically negative axillae from the morbidity of complete axillary dissection. Ideally the sentinel nodes should be able to identified in more than 95% of patients, with a false-negative rate of less than 5%. Until these rates can be achieved consistently, however, surgeons should not abandon traditional axillary dissection.     

Role of tranexamic acid in axillary lymph node dissection in breast cancer patients

Axillary lymph node dissection (ALND) is an important step in the management of node‐positive operable breast cancer. It is associated with large amount of axillary drainage and increased risk of wound‐related infection. Tranexamic acid (TA) has antifibrinolytic property and is being extensively used in controlling blood loss. However, its role in reducing axillary drainage after ALND is still not well‐established. The aim of this study is to evaluate the effectiveness of TA in reducing the axillary drainage, early removal of the drain, and decreasing the wound‐related infection in breast cancer patients undergoing ALND. This is a prospective nonrandomized double‐armed cohort study. Total of 47 patients were included in the TA group and 46 in the nontranexamic (NTA) group. All the patients in TA group received a single dose of intravenous (IV) TA at the time of induction followed by oral TA for five days after surgery. Both TA and NTA groups had similar proportions of locally advanced breast cancers (57.4% vs 56.5%, P = .90). Majority of them underwent modified radical mastectomy (MRM) (70.2% vs 67.4%, P = .76). Patients in TA group had significantly lower axillary drainage (440 ml vs 715.5 ml, P = .003) with earlier removal of the drain (8 vs 11 days, P = .046). Seroma formation (19.1% vs 32.6%, P = .13) and wound‐related infection (4.3% vs 8.7%, P = .43) were nonsignificantly lower in the TA group. Tranexamic acid reduces axillary drainage and facilitates early removal of the drain after axillary lymph node dissection.     

Safety of elective hand surgery following axillary lymph node dissection for breast cancer

The development of lymphedema is the most feared complication shared by breast cancer survivors undergoing hand surgery after prior axillary lymph node dissection (ALND). Traditionally, these patients are advised to avoid any interventional procedures in the ipsilateral upper extremity. However, the appropriateness of some of these precautions was recently challenged by some surgeons claiming that elective hand operations can be safely performed in these patients. The purpose of this study was to evaluate our experience and determine the safety of elective hand operations in breast cancer survivors. The medical records of patients operated for different hand conditions after prior breast surgery and ALND at our institution between 1983 and 2002 were reviewed. The techniques and preventive measures performed, use of antibiotics, and upper extremity complications associated with the operations were analyzed. Overall, we operated on 27 patients after prior ALND performed for breast cancer. Follow-up was available for 25 patients. Four patients had pre-existing lymphedema. The surgical technique used was similar to that performed in patients without prior ALND and antibiotic prophylaxis was not given. Delayed wound healing was observed in one patient and finger joint stiffness in another. Two patients with pre-existing lymphedema developed temporary worsening of their condition. None of the patients developed new lymphedema. The results of the present study support the few previous studies, suggesting that hand surgery can be safely performed in patients with prior ALND. Based on these findings, the appropriateness of the rigorous precautions and prohibitions regarding the care and use of the ipsilateral upper extremity may need to be reconsidered.     

乳腺癌患者腋窝淋巴清扫术后上肢自我感觉症状分布特点及症状群研究

目的探讨乳腺癌患者腋窝淋巴清扫术后上肢自我感觉症状以及症状群的分布特点,为症状管理提供指导。方法选取乳腺癌腋窝淋巴清扫术后患者343例为研究对象,采用自编的上肢自我感觉症状调查表对其进行调查。结果患者上肢存在多种症状,发生率最高的3个症状分别是紧缩感(62.39%)、僵硬感(59.48%)、麻木感(42.86%)。上肢疼痛感(47.94%)、压痛感(17.81%)在术后3个月内发生率最高,随着术后时间延长,发生率逐渐降低且差异有统计学意义(均P0.01);上肢紧缩感(79.10%)、麻木感(55.22%)、僵硬感(77.61%)、感觉迟钝(28.36%)、无力感(58.21%)在术后3~6个月发生率最高,其中紧缩感、麻木感、僵硬感、无力感4个症状随术后时间的延长,发生率逐渐降低且差异有统计学意义(P0.05,P0.01);上肢沉重感(32.20%)、肿胀感(37.29%)在术后12~24个月发生率最高,术后不同时间段发生率比较,差异无统计学意义(均P0.05)。探索性因子分析得出4个症状群:因子1为瘢痕组织牵拉相关症状群(紧缩感、僵硬感);因子2为手术创伤相关症状群(疼痛感、压痛感、无力感);因子3为上肢淋巴水肿相关症状群(沉重感、肿胀感);因子4为肋间臂神经损伤相关症状群(感觉迟钝、麻木感)。结论乳腺癌患者腋窝淋巴清扫术后存在多个症状,且以群集现象存在。护理人员进行症状管理时根据症状分布和群集特点采取针对性的干预措施,以减轻患铡上肢不适感。     

Positive sentinel lymph node biopsy predicts the number of metastatic axillary nodes of breast cancer

It remains to be clarified whether a positive sentinel lymph node biopsy (SLNB) can predict the number of metastatic axillary nodes. This study examined a consecutive series of women with unilateral invasive breast cancer who underwent axillary lymph node dissection after an intra-operative positive SLNB. The numbers of positive and negative sentinel lymph nodes (SLNs) were analyzed for a likelihood of pN1a, pN2a, and pN3a diseases as per the UICC TNM classification. Of the 368 study patients, 165 (45%) had one positive SLN and one or more negative SLNs. This result represented the most common combination of positive and negative SLNs. It was also the most predictive indicator (93%) of pN1a disease and the least predictive indicator (7% or 0%) of pN2a or pN3a disease, respectively. The numbers of positive and negative SLNs can predict the number of metastatic axillary nodes in breast cancer patients.