【摘要】 目的 探讨乳腺癌保乳切除加经乳腔镜清扫腋窝淋巴结的可行性和手术难点。 方法 将2007年2月－2011年2月行乳腺癌保乳切除手术的27例患者，分成乳腔镜腋窝清扫组（乳腔镜组）11例和常规腋窝清扫组（常规组）16例，比较两组患者手术时间、术中出血量、术中清扫淋巴结数、术后引流时间及引流量等。 结果 手术时间:乳腔镜组（186.36±11.20） min，常规组（158.13±25.29） min，两组差异有统计学意义（P=0.002）；术中出血量:乳腔镜组（61.82±51.54） mL，常规组（103.75±42.56） mL，两组差异有统计学意义（P=0.030）；两组术中清扫淋巴结个数、术后引流时间、引流量比较，差异均无统计学意义（Pgt;0.05）；随访1个月~4年，无一例发生肿瘤局部复发或戳孔转移。 结论 乳腺保乳切除加经乳腔镜清扫腋窝淋巴结可以安全应用于早期乳癌的保乳治疗，操作者需学习一定的手术技巧。【Abstract】 Objective To investigate the feasibility and surgical difficulty of breast-conserving resection and endoscopy-assisted axillary lymph node dissection for breast cancer patients. Methods Twenty-seven patients treated by breast-conserving surgery from February 2007 to February 2011 in our hospital were divided into endoscopy-assisted axillary lymph node dissection group (the EALND group, n=11) and conventional axillary lymph node dissection group (the CALND group, n=16). Then, we compared the operation time, intra-operative bleeding volume, number of lymph nodes dissected, postoperative drainage time and amount between the two groups. Results The operation time was significantly longer in the EALND group than that in the CALND group [(186.36±11.20) vs. (158.13±25.29) minutes, P=0.002]. The intra-operative bleeding volume of the EALND group was significantly less than that of the CALND group [(61.82±51.54) vs. (103.75±42.56) mL, P=0.030]. There were no significant differences between the two groups in the number of lymph nodes dissected, postoperative drainage time and amount. Follow-up was done for one month to four years, during which no local recurrence or trocar displacing occurred. Conclusion The breast-conserving resection and endoscopy-assisted axillary lymph node dissection can be safely used in early breast cancer patients, and surgical skills should be mastered in the study.
目的 探讨乳腺癌改良根治术中保留肋间臂神经（ICBN）的临床效果。方法 笔者所在医院2005年3月至2009年3月期间行乳腺癌改良根治术54例，其中保留ICBN 39例，未能保留者15例，术后严密追踪观察。结果 保留ICBN和未能保留ICBN患者术后1个月皮肤感觉异常者分别为5例（12.8%）和13例（86.7%），两者差异有统计学意义（P＜0.01）；保留ICBN感觉异常者均在术后2～3个月内恢复正常，未保留ICBN感觉异常者3个月后症状稍有改善，有7例6个月后仍未恢复。全部病例均获随访，随访时间6～36个月，平均22个月，无复发。结论 保留ICBN能减少乳腺癌患者术后上肢感觉障碍的发生，提高其生活质量。
ObjectiveTo summarize the current situation and progress of sentinel lymph node biopsy (SLNB) in breast cancer. MethodsDomestic and foreign documents related SLNB in breast cancer in recent years were collected to summaize some problems about the definition, indications, biopsy techniques, improvement methods of the detection rate, the pathological examinations of sentinel lymph node (SLN), the types of metastasis, clinical applications of SLNB technology in breast cancer, and so on. ResultsThe indications of SLNB were expanding. The development of the tracer, imaging examination, and pathological detection technology contributed to the status assessment of SLN in breast cancer. The operation method of SLNB in breast cancer had no uniform standards yet. There were many arguments on whether SLNB can guide axillary lymph node dissection, and the detection rate and the false negative rate of it varied widely. ConclusionsSLNB technology has became an important method in the surgical therapy of breast cancer, but the operation still needs to be further standardized. The clinical application of SLNB also needs a lot of prospective multicenter randomized experiments for further demonstration.
ObjectiveTo discuss the strategy of locoregional surgery for breast cancer patients after neoadjuvant chemotherapy. MethodThe pertinent literatures about locoregional surgery concerning breast-conserving therapy, factors of ipsilateral breast tumor recurrence, pathological shrinkage modes of breast primary tumor, and sentinel lymph node biopsy after neoadjuvant chemotherapy were reviewed. Results①The major benefit of neoadjuvant chemotherapy was to increase the proportion of breast-conserving therapy after downstaging the primary breast tumor. However, the use of breast-conserving therapy after neoadjuvant chemotherapy might remain a higher risk of ipsilateral breast tumor recurrence. It was now widely recognized that the risk factors for ipsilateral breast tumor recurrence were multifocal pattern of residual tumor and pathologic residual tumor larger than 2 cm. The shrinkage mode of the primary breast tumor after neoadjuvant chemotherapy and its relative factors were still unclear. 2 Sentinel lymph node biopsy(SLNB) was feasible either before or after neoadjuvant chemotherapy and approval by SLNB guideline and expert consensus. Patients with a cN0 status could get more benefits from SLNB after neoadjuvant chemotherapy. Although there was a bright future for SLNB as an alternative to ALND for patients with primary cN1 and downstaging to cN0 after neoadjuvant chemotherapy, it needed to obtain the accepted clinical identification rate, false negative rate, as well as similar regional recurrence rate and overall survival as compared to ALND. ConclusionsCurrently, surgical management is crucial for reducing the locoregional recurrence risk of breast cancer after neoadjuvant chemotherapy, no matter what the clinical and radiographic efficacy of neoadjuvant chemotherapy is. In the era of genomics and SLNB, individual locoregional surgical management could be arrived according to the primary stage and neoadjuvant chemotherapy response.
ObjectiveTo explore influence of molecular classification of breast cancer on surgical treatment of axillary lymph nodes. MethodThe related literatures which discussed the relation between molecular classification and axillary lymph node metastasis were reviewed and analyzed. ResultsThe triple negative breast cancer had a lower rate of sentinel lymph node or non-sentinel lymph node metastasis. The axillary lymph node metastasis rate was higher in the luminal B or HER-2 overexpression subtypes. Especially, luminal B subtype had a higher risk of sentinel lymph node or non-sentinel lymph node metastasis as compared with the other subtypes. Elderly patients with breast conserving operation could be free for axillary lymph node dissection when only 1-2 sentinel lymph node metastases. There was still a positive possibility of non-sentinel lymph node for younger patients with a larger tumor size, even if the sentinel lymph node negative, the lymph node dissection may benefit these patients. ConclusionBreast cancer molecular classification should be considered for the surgery selection of axillary lymph node dissection.