乳腺癌前哨淋巴结活检与腋清扫术后早期患侧上肢功能状况对比

目的：对比分析前哨淋巴结阴性乳腺癌仅行前哨淋巴结活检（ SLNB）与腋窝淋巴结清扫（ ALND）术后早期肩关节功能障碍及上肢淋巴水肿发生情况。方法选择40例前哨淋巴结阴性乳腺癌患者，随机分为SLNB组（ n＝20）和ALND组（ n＝20）。结果①SLNB组上臂周径在术后第1、2、4周时均与术前接近（P＝0．067、P＝0．212、P＝0．698）；ALND组在术后第1、2周时大于术前（P＝0．004、P＝0．012），第4周时与术前接近（P＝0．204）。②SLNB组Neer肩关节功能评分在术后第1、2周时均小于术前（P＝0．000、P＝0．000），第4周时恢复至术前水平（P＝0．163）。 ALND组Neer肩关节功能评分在术后第1、2、4周时均小于术前（P＝0．000、P＝0．000、P＝0．000）。③术前Neer肩关节功能评分与肩关节外展角度SLNB组与ALND组差异均无统计学意义（P＝0．284、P＝0．558）。术后第4周SLNB组均高于ALND组（P＝0．000、P＝0．000）。结论前哨淋巴结阴性的乳腺癌患者，SLNB替代ALND可以明显降低术后早期肩关节功能障碍及上肢淋巴水肿的发生。

Comparative clinical research of ipsilateral upper extremity function in early stage after sentinel lymph node biopsy or axillary lymph node dissection in patients with breast cancer

Objective To compare the incidence of shoulder dysfunction and upper extremity lymph edema in early postoperative period between SLNB and ALND after sentinel lymph node biopsy for breast cancer patients with sentinel lymph node -negative.Methods Totally 40 patients with breast cancer with sentinel lymph node -negative were randomly divided into SLNB group （ n=20 ） and ALND group（n=20）.Results ①In patients with SLNB the circumferences of upper arm in one,two,and four weeks after operation were similar to those before operation（P=0.067,P=0.212,and P=0.698,respectively）.While in patients with ALND,the circumferences of upper arm in one or two weeks after operation were significantly bigger than those before operation（P=0.004,P=0.012,respectively）,and the circumference in four weeks after operation was similar to that before operation （ P=0 .204 ） .②In patients with SLNB the Neer shoulder joint function scores in one and two weeks after operation were smaller than those before operation （P=0.000,P=0.000,respectively）, and the score in four weeks after operation was similar to that before operation（P=0.163）.However,in patients with ALND,the scores in one,two or four weeks after operation were smaller than those before operation（P=0.000,P=0.000,and P=0.000,respectively）.③Be-fore operation,the Neer shoulder joint function score and outreach angles of shoulder joint between patients with SLNB and ALND were both smaller（P=0.284,P=0.558,respectively）.However,four weeks after operation,the scores and angles in patients with SLNB were both higher than those with ALND（P=0.000,P=0.000,respectively）.Conclusion For breast cancer patients with sentinel lymph node -negative,SLNB substituting ALND can reduce the incidence of shoulder dysfunction and upper extremity lymph edema in early postoperative period.