乳腺癌改良根治术保留肩胛下肌群筋膜的腋窝淋巴结清扫对腋窝积液的影响

目的 探讨乳腺癌改良根治术腋窝淋巴结清扫保留肩胛下肌群筋膜的方法对腋窝积液的影响.方法 将我院2010年1月～2010年12月确诊乳腺癌并需行乳腺癌改良根治术的患者共178例随机分为保留肩胛下肌群筋膜腋窝淋巴结清扫组（治疗组,n＝98）及切除全部肩胛下肌群筋膜腋淋巴结清扫组（对照组,n＝80）,比较两组在切除淋巴结平均数目、拔引流管时间,腋窝皮下积液发生率及患侧上肢水肿发生率的情况.结果 治疗组切除腋窝淋巴结平均数、腋窝皮下积液例数（发生率）、拔管时间、拔管时间超过14天例数及发生患侧上肢水肿例数依次为：15.1个/例,6例（6.1%）、7±0.5天、4例及3例,对照组为14.8个/例、9例（11.3%）、9±0.5天、12例及7例.两组均未发生严重水肿.治疗组与对照组在切除淋巴结平均数目无显著差异,但前者拔管时间较后者短,腋窝皮下积液发生率及患侧上肢水肿发生率均较对照组低,两组差异具有统计学意义.结论 保留肩胛下肌群筋膜腋窝淋巴结清扫的方法较常规方法损伤更小,发生腋窝皮下积液及患侧上肢水肿的几率低,不影响肿瘤分期.

Effect of axillary hydropsy on axillary lymph node dissection of preserving subscapular muscle group fascia during modified radical operation of breast cancer(A report of 178 cases)

Objective To investigate the influence as subcutaneous effusion of retention of the subscapularis muscle group fascia in modified radical mastectomy for breast cancer.Methods 178 cases with breast cancer underwent modified radical mastectomy from January to December in 2010 in our hospital.The patients were randomly divided into treatment group(retention of the subscapularis muscle group fascia in axillary dissection,n =98)and the control group(non-retention of the subscapularis muscle group fascia in axillary dissection,n=80).The mean number of resected lymph nodes,pull tube drainage time,the rate of axillary subcutaneous effusion and incidence of ipsilateral upper limb edema were compared in the two groups.Results The average number of resected lymph nodes in two groups showed no statistic diference.The rate of axillary subcutaneous effusion,extubation time,the number of cases with extubation time more than 14 days and cases of ipsilateral upper extremity edema in the treatment group were as followed:15.1 per-case,6 cases(6.1%),7±0.5 days,4 cases and 3 cases,respectively.Parallelism in the control group:14.8 per-case,9 cases(11.3%),9±0.5 days,12 cases and 7 cases.No serious edema occured in two groups.The extubation time is shorter and the incidence axillary subcutaneous effusion was lower in the treatment group,and showed significant difference.Conclusion Retention of the subscapularis muscle group fascia in modified radical mastectomy for breast cancer showed smaller damage,lower rates in occurrence of axillary subcutaneous effusion and ipsilateral upper limb edema.The long-term effect of the safety on oncology still need further follow-up observation.