腔镜下乳腺癌前哨淋巴结活检临床应用及效果分析

目的探讨在腔镜下进行乳腺癌前哨淋巴结活检(SLNB)的可行性及手术效果。方法分析笔者所在医院2009年1月至2012年3月期间行乳腺癌SLNB病例,其中腔镜下活检107例,开放活检303例,采用放射性核素+亚甲蓝联合法与单用亚甲蓝法进行前哨淋巴结(SLN)探测。结果开放组SLN检出率联合法为94.56%(139/147),亚甲蓝法为88.46%(138/156);腔镜组联合法为94.25%(82/87),亚甲蓝法为85.00%(17/20)。检出前哨淋巴结数量,开放组联合法平均1.90枚/例,亚甲蓝法平均1.98枚/例;腔镜组则分别为1.91枚/例和1.82枚/例。SLN阳性率联合法及亚甲蓝法开放组分别为22.30%(31/139)和25.36%(35/138);腔镜组分别为19.51%(16/82)和23.53%(4/17)。上述各指标2组间的差异均无统计学意义(P>0.05)。术后并发症:腔镜组发生皮下积液的比例(5/107)高于开放组(0/303),P=0.001;其他并发症发生情况2组间比较差异均无统计学意义(P>0.05)。结论腔镜下SLNB与传统SLNB可达到相似的安全性与临床效果,但前者表现出较优越的美容效果,腔镜下SLNB可作为乳腺癌SLNB手术技术进行推广应用。

Endoscopic Sentinel Lymph Node Biopsy in Breast Cancer: Clinical Application and Effect Analysis

Objective To investigate the feasibility and operation effect of endoscopic sentinel lymph node biopsy(SLNB)in breast cancer.Methods The data of 410 breast cancer patients who underwent SLNB(including 107 patients with endoscopy and 303 with open operation)were analyzed in our hospital from January 2009 to March 2012.SLNB was performed by using methylene blue staining or the combination of methylene blue and 99Tcm-sulfur colloid tracing.Results The successful rate of SLN detection with methylene blue and99Tcm-sulfur colloid tracing was 94.56%(139/147)in open operation group and 94.25%(82/87)in endoscopy group.The successful rate of SLN detection with methylene blue was 88.46%(138/156)in open operation group and 85.00%(17/20)in endoscopy group.The mean of detected SLN number with combined method or methylene blue was 1.90/1.98 in open operation group and 1.91/1.82 in endoscopy group respectively.SLN-positive rate was 22.30%(31/139)and 25.36%(35/138)in open operation group,and 19.51%(16/82)and 23.53%(4/17)in endoscopy group,respectively.The rate of subcutaneous effusion in endoscopy group was higher than that in open operation group(P=0.001),but other postoperative complications presented no significant difference.Conclusions Endoscopic SLNB can obtain the similar safety and the clinical efficacy with traditional SLNB,but superior cosmetic effect.So it is worthy of clinical application in breast cancer.