乳癌术中应用脂肪溶解液的疗效评价

目的对乳腺癌改良根治术中注射脂肪溶解液后行脂肪抽吸辅助腋淋巴结清扫以保留腋窝相关神经血管及淋巴管的方法进行疗效评价。方法将71例确诊乳腺癌并有改良根治术指征的患者随机分为试验组（36例）和对照组（35例），对照组术中按传统方法清扫腋窝脂肪、淋巴结，尽量避免损伤并保留区域神经、血管分支；试验组术中于腋窝注射脂肪溶解液，抽吸脂肪后行腋淋巴结清扫术，清扫过程中不切断大的分支血管，完整保留胸长神经、胸背神经、肋间皮神经。结果试验组平均手术完成时间82min、术中出血量21ml，优于对照组平均手术完成时间116min、术中出血量38ml（P〈0．05）试验组患侧肩关节活动障碍2例，患侧上肢水肿4例，术区麻痹疼痛3例，与对照组比较差异有显著性（P〈0．05）。结论乳腺癌改良根治术中采用注射脂肪溶解液后行脂肪抽吸辅助腋淋巴结清扫术具有操作简便、有效缩短手术时间的作用，清扫较彻底，同时保留并减少损伤腋窝主要神经、血管及淋巴管，且能显著减少术后并发症。

The efficacy of fat-soluble liquid in the surgical treatment of breast cancer

Objective To evaluate the efficacy of modified radical mastectomy with fat suction plus axillary lymph node dissection after injections of fat-soluble liquid to preserve the axillary nerve and lymphatic vessels. Methods 76 patients who indications of modified radical mastectomy were randomized to study group (36 patients) and control group (35 patients). The patients in the control group received conventional axillary node dissection and fat resection, with preservation of regional nerve branch and vessels.The patients in the study group received axillary injections of fat-soluble liquid and then axillary node dissection after fat suction, with preservation of the large vessel branch and intact long thoracic nerve, thoracodorsal nerve, and intercostal nerve. Results The average surgical duration was shorter and intraoperative blood loss was less in the study group than in the control group. All the patients had better recovery and received subsequent chemotherapy and/or radiotherapy based on axillary lymph node metastases; no recurrence was found during a 1-year follow-up. Postoperative complications including motor dysfunction of the affected shoulder joint, upper limb edema, and numbness and pain in the surgical area were significantly fewer in the study group than in the control group (P<0.05). Conclusions Modified radical mastectomy with fat suction plus axillary lymph node dissection after injections of fat-soluble liquid is simple and effective role in reducing surgical duration, more completely dissecting lymph nodes and preventing damages to the major axillary nerves and blood and lymphatic vessels, and significantly decreasing postoperative complications.