肿胀法乳腺癌腋窝淋巴结清扫术的可行性和安全性研究

目的探讨肿胀法用于乳腺癌腋淋巴结清扫术（axillarylymphadenectomybytumescenttechnique，ALTT）的可行性及安全性。方法60例患者按入院顺序分成2组，每组30例，分别行ALTT及传统手术，比较两组手术时间、淋巴结清扫数目、肋间臂神经保留及病理改变情况、手术野脱落细胞情况、术后并发症等。结果ALTT组腋淋巴结平均清扫时间（26．47±4．09）min，较传统时间缩短（P〈0．05）；术中平均出血量（80．33±8．70）ml，与传统手术相比差异有显著性（P〈0．01）；平均腋淋巴结清扫数目（21．50±4．56）个，明显高于对照组（P〈0．01）；肋间臂神经保留率40％，与对照组相比，差异有显著性（P〈0．05）；两组术后淋巴结病理学改变无显著差异，创面冲洗液脱落细胞学镜检均未发现阳性，术后平均随访6个月，上臂内侧感觉麻木疼痛明显少于对照组（P〈0．05），所有患者均无局部复发、切口种植。结论肿胀法乳腺癌腋淋巴结清扫术简单省时，淋巴结清扫率高，尤其对于肋间臂神经的保留，减少术后并发症有重要意义。

Feasibility and safety of axillary iymphadenectomy by tumescent technique in patients with breast cancer

Objective To evaluate the feasibility and safety of axillary lymphadenectomy by tumescent technique in patients with breast cancer. Methods Sixty patients with operable breast cancer were assigned to receive axillary lymph node dissection by tumescent technique （TT） or by conventional technique （CT）, with 30 cases in each group. Operative time, number of lymph node dissected and pathological changes, preservation of intercostobrachial nerve （ICBN）, exfoliated cells in fluid of operating fields and postoperative complications were analyzed and compared between two groups. Results The average time of lymph node dissection in TT group was shorter than that in CT group I （26.47 ± 4.09） min vs （29.47 ± 4.70） min, P 〈 0. 05 ] ; the mean intraoperative blood loss inTTgroup was less than that in CT group （80.33 ± 8.70） ml vs （97.80±11.39） ml, P〈 0.01） The ICBN preservation in TT group was significantly more than that in CT group （ 12/30 vs 3/30, P 〈 0. 05 ）. The average number of dissected nodes in TT group was significantly more than that in CT group （21.50 ±4. 56 vs 17.17 ± 4.94, P 〈 0. 01 ）. No difference in pathological changes of dissected nodes was seen between two groups （P 〉 0. 05 ）. The exfoliated cytology in fluid of operating fields were negative in two groups. After an follow-up of 6 months, the numbness and pain of upper arm in TT group was significantly less than that in CT group （P 〈 0. 05 ）, all patients had no local recurrence and the incision implanting. Conclusion Axillary lymphadenectomy by tumescent technique has the advantage of ICBN preservation, high rate of lymph node dissection, less blood loss and postoperative complications compared to the surgery by conventional technique.