乳腺癌再次腋窝淋巴结清扫36例分析

目的探讨乳腺癌手术后腋窝淋巴结转移以及不规范性手术后残留实施再手术的可行性。方法制定纳入标准,回顾性分析我院2001年6月至2010年8月间再次腋窝淋巴结清扫手术的36例乳腺癌患者的临床病理资料,再次手术围手术期综合性治疗措施及其术后1、3、5年随访资料。结果全组非规范性手术19例占52.78%(原腋窝残留包块再次清扫11例,胸壁复发包块切除及腋窝淋巴结清扫8例)。原改良根治术11例、Halsted术6例患者术后单纯腋窝复发12例(33.33%),腋窝及胸壁复发性包块5例(13.89%);实施腋窝淋巴结清扫或加胸壁包块切除术。全组病例腋下共检出346枚淋巴结,平均17.78枚(7～35枚),阳性淋巴结58枚占16.76%(1～13枚),部分病例有淋巴结融合。再次手术后均给予4～6疗程化疗或放疗,少数辅以免疫治疗等综合性治疗措施。术后1年内死亡2例,3年内10例,5年15例其1,3,5年生存率分别为94%、72%、58%。结论规范性手术是防止乳腺癌术后复发转移的关键措施,对局部复发、腋窝淋巴结转移可切除患者再次手术有助于控制局部病情的发展,再次手术围手术期规范性治疗可以改善患者的生存质量。

Re-dissection of axillary lymph nodes in 36 cases with recurrent breast cancer

Objective To explore the feasibility of re-operation for the cases with postoperative axillary lymph nodes metastases and regional residual because of non-standard surgery.Methods From June 2001 to August 2010,36 patients with re-dissection of axillary lymph nodes were included,and their clinical pathological data,perioperative comprehensive treatment measures,and 1,3,5-year follow-up data were retrospectively analyzed.Results Nineteen cases were treated with non-standard surgery(52.78%,axillary residual mass re-dissection in 11 cases vs.recurrent chest wall mass excision plus axillary lymph node dissection in 8 cases).Another 17 cases received axillary lymph node dissection or plus chest wall mass resection(modified radical mastectomy in 11 cases vs.Halsted in 6 cases;axillary recurrence in 12 cases vs.axillary and chest wall recurrence in 5 cases).Total 346 axillary lymph nodes were found in all the cases,with an average number of 17.78(7~35),in which positive lymph nodes were 16.76%(58,1~13).After the second time operation,all the cases were treated with 4~6 cycles of chemotherapy or radiotherapy,and some with immunotherapy.For the post-operative follow up,2 patients died within 1 year,10 cases died within 3 year,and 15 patients died within 5 year.And the 1,3,5-year survival rates were 94%,72%,58%,respectively.Conclusions Standardized surgery is a crucial and effective procedure for the cases with breast cancer to prevent recurrence and metastasis.For the patients with local recurrence and/or axillary lymph node metastasis,re-operation would help to control the advancement,and perioperative standardized treatment would also help to improve the quality of life.