纳米炭在乳腺癌改良根治术中淋巴示踪效果的临床研究

目的探讨钠米炭混悬液不同注射部位对乳腺癌腋窝淋巴结的示踪效果及其对乳腺癌改良根治术安全性的影响。方法收集绵阳市中心医院2012年3月至2013年5月期间行乳腺癌改良根治术的乳腺癌患者88例,按入院日期分为乳晕组（n=44）和肿瘤周缘组（n=44）。术前麻醉诱导后,乳晕组于乳晕区注入钠米炭,肿瘤周缘组于肿瘤周缘注入。比较2组患者的淋巴结检出数量、转移淋巴结检出数量、淋巴结黑染率及手术效果相关指标。结果乳晕组共检出淋巴结1 453枚,其中黑染淋巴结的数量为1 396枚（96.1%）;淋巴结检出数量为（33.0±7.1）枚/例;19例（43.2%）检出转移淋巴结220枚,转移淋巴结检出数量为（5±2）枚/例;手术时间为（122.1±10.2）min,术中出血量为（83.8±10.1）mL,术后住院时间为（7±1）d,术后有3例患者（6.8%）发生并发症。肿瘤周缘组共检出淋巴结909枚,其中黑染淋巴结的数量为594枚（65.3%）;淋巴结检出数量为（20.7±3.2）枚/例;20例（45.5%）检出转移淋巴结88枚,转移淋巴结检出数量为（2±1）枚/例;手术时间为（121.6±11.4）min,术中出血量为（84.2±11.3）mL,术后住院时间为（7±2）d,术后有3例患者（6.8%）发生并发症。乳晕组的淋巴结黑染率、淋巴结检出数和转移淋巴结检出数均高于肿瘤周缘组（P〈0.01）,而2组手术时间、术中出血量、术后住院时间及术后并发症发生率的差异均无统计学意义（P〉0.05）。结论麻醉诱导后于乳晕区注射纳米炭混悬液方法的淋巴示踪效果明显优于肿瘤周缘注射法,而且不增加手术并发症发生率,值得推广。

Effect of Carbon Nanoparticles Dyeing on Axillary Lymph Node Dissection in Modifi ed Radical Mastectomy for Breast Cancer

Objective To explore the effect of carbon nanoparticles dyeing on axillary lymph node dissection in modified radical mastectomy for breast cancer. Methods Eighty-eight patients with breast cancer who received modified radical mastectomy in Mianyang Central Hospital between Mar. 2012 and May. 2013 were recruited in the study, and they were equally divided into areola group and peripheral tumor group. After induction of anesthesia before operation, carbon nanoparticles were injected around the areolar in the areola group, and carbon nanoparticles were injected around the tumor in the peripheral tumor group. The number of dissected lymph nodes（be dyed or not be dyed）, metastatic lymph nodes, and black dyed lymph nodes, as well as value of operation related indexes were recorded and compared. Results In the areola group, lymph nodes were detected in 1 453, in which 1 396 lymph nodes were stained black（96.1%）;the average number of dissected lymph nodes were 33.0±7.1 per case;and 19 patients（43.2%, in total of 220 metastatic lymph nodes） of them were suffered from lymph node metastasis with the average number of metastatic lymph nodes of 5±2 per case. In addition, in the areola group, operative time were（122.1±10.2） min, blood loss were（83.8±10.1） mL, postoperative hospital stay were（7±1） d, and postoperative complications occurred in 3 patients. In the peripheral tumor group,lymph nodes were detected in 909, in which 594 lymph nodes were stained black（65.3%）;the average number of dissected lymph nodes were 20.7±3.2 per case;20 patients（45.5%, in total of 88 metastatic lymph nodes） of them were suffered from lymph nodes metastasis, with the average number of metastatic lymph nodes of 2±1 per case. In addition,in the peripheral tumor group, operative time were（121.6±11.4） min, blood loss were（84.2±11.3） mL, postoperative hospital stay were（7±2） d, postoperative complications occurred in 3 patients. The black staining rate of lymph nodes, the number of lymph nodes ret