乳腔镜和常规腋窝淋巴结清扫淋巴结病理改变的随机对照研究

目的研究乳腔镜与常规腋窝淋巴结清扫手术腋窝淋巴结的病理改变。方法随机对照分析200例乳腔镜和常规各100例的腋窝淋巴结清扫手术收获的淋巴结总数、转移淋巴结比例、平均每例收获淋巴结数、平均淋巴结大小以及淋巴结病理形态变化。结果乳腔镜组和常规组在收获淋巴结总数(1 781枚和1 737枚)、转移淋巴结比例(11.9%和13.4%)、平均每例收获淋巴结数(17.8±5.8和17.4±4.9)以及平均淋巴结大小(0.33和0.38 cm)方面差异无统计学意义(P均>0.05)。2组总共3518枚淋巴结病理形态变化(包括淋巴结膜破裂、淋巴结内出血、淋巴结囊分离和淋巴结碎裂)的分析,乳腔镜组和常规组中淋巴结出现病理形态改变分别占6.8%和6.2%,2组差异无统计学意义(P>0.05)。结论相对于常规腋窝淋巴结清扫手术,脂肪抽吸法乳腔镜腋窝淋巴结清扫术并不影响淋巴结的整体病理性质,不会对淋巴结造成更多的损伤,没有增加淋巴结病理形态改变的可能性。脂肪抽吸法乳腔镜腋窝淋巴结清扫手术不增加手术的危险,具有肿瘤学安全性。

Randomized comparison of the pathologic changes of lymph node between mastoscopic and conventional axillary lymph node dissection

Objective To study the pathologic changes of lymph node between mastoscopic and conventional axillary lymph node dissection.Methods A group of 200 consecutive patients with operable breast cancer were prospectively randomized to undergo axillary lymph node dissection by mastoscopic or conventional approach. The total lymph node numbers, ratio of metastatic lymph node, mean lymph nodes harvested, mean lymph node size and pathologic changes of lymph node were compared. Results There was no significant difference (P>0.05) between the two groups regarding the total lymph node numbers(1 781 in mastoscopic group vs 1 737 in conventional group), ratio of metastatic lymph node(11.9％vs 13.4％), mean lymph nodes harvested(17.8±5.8 vs 17.4±4.9), mean lymph node size (0.33 vs 0.38 cm). The morphologic changes included rupture of the membrane of lymph node, hemorrhage in lymph node, capsular detachment and fragmentation. The change was 6.8% for the mastoscopic group versus 6.2% for the conventional group in total 3 518 lymph nodes in the two groups (P>0.05). Conclusion Compared with conventional axillary lymph node dissection, mastoscopic axillary lymph node dissection by liposuction did not affect the pathologic characteristics of lymph nodes. It did not cause more injury to lymph nodes. This operation is safe and useful in the oncology.