乳腺癌改良根治术L_3淋巴结清扫方式改进的临床应用研究

目的探讨对临床腋淋巴结阳性乳腺癌患者行改良根治术时采用改进L3淋巴结清扫方式的临床应用及意义。方法选择154例临床腋淋巴结阳性乳腺癌患者,临床分期Ⅱa期58例,Ⅱb期75例,Ⅲa期21例,采用改进的L3淋巴结清扫方式,对术后病理结果进行分析,同时随访观察患者的无病生存率。结果 154例患者中有腋淋巴结转移143例,占92.85%,有19例患者L3淋巴结转移,术前临床分期为Ⅱa期58例,L3淋巴结转移3例（5.17%）,Ⅱb期75例,L3淋巴结转移10例（13.33%）,Ⅲa期21例,L3淋巴结转移6例（28.57%）,术前临床分期与L3淋巴结阳性病理结果呈正相关性（r=0.215,P=0.007）,L3淋巴结未转移患者5年无病生存率为58.3%,L3淋巴结转移患者5年无病生存率为28.1%,2组差异有统计学意义。结论对临床腋淋巴结阳性乳腺癌患者行L3淋巴结清扫具有一定的临床应用价值,采用改进的淋巴结清扫方式,便于L3淋巴结的清扫。

Clinical research of improved modality about L_3 axillary lymph node dissection in breast cancer

Objective To identify the clinical application and significance of modified radical mastectomy about improved L3 axillary lymph node dissection in clinically apparent axillary lymph nodes of patients with breast cancer.Methods One hundred and fifty four patients with clinically apparent axillary lymph nodes were collected,clinically stage groupings： Ⅱa 58 cases,Ⅱb 75 cases,Ⅲ 21 cases,they were operated by improved L3 axillary lymph node dissection,regional lymph nodes removed for pathological study.Then followed up their disease-free survival.Results： One hundred and forty three（92.85%） patients had pathological apparent axillary lymph nodes.19 of them had apparent L3 axillary lymph node.There were 58 patients in clinically stage groupings Ⅱa,3（5.17%）of them had apparent L3 axillary lymph node;75 patients were in clinically stage groupings Ⅱb,10（13.33%） of them had apparent L3 axillary lymph node;21 patients were in clinically stage groupings Ⅲa,6（28.57%） of them had apparent L3 axillary lymph node,the clinically stage groupings had postive correlation with pathological apparent L3 axillary lymph（r=0.215,P=0.007）.5 years disease-free survival of patients with negative L3 axillary lymph were 58.3%,and the postive groups were 28.1%,differences of the two group has statistical significences.Conclusion There were specified clinically meaning for patients with clinically apparent axillary lymph nodes,they were operated by improved L3 axillary lymph node dissection,and this will make it easy in dissect L3 axillary lymph node.