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目的:探讨乳腺癌腋窝淋巴清扫术(axillary lymph node dissection,ALND)中腋窝逆行淋巴显影(axillary reverse mapping,ARM)联合细针穿刺活检(fine needle aspiration cytology,FNAC)预防术后上肢淋巴水肿的作用。方法 :选取2013年1月~12月乳癌患者,随机分为对照组与选择组,均行ARM与FNAC。对照组切除ARM淋巴结;选择组ARM淋巴结如为阳性、可疑或无法确定则予以切除,阴性则予以保留。结果:入组乳腺癌72例,对照组35例,选择组37例,均在腋区成功显影ARM淋巴结。对照组细针穿刺ARM淋巴结阳性1例(2.9%),可疑3例(8.6%),无法确定6例(17.1%),术后组织病理示阳性2例(5.7%);选择组细针穿刺阳性2例(8.1%),可疑2例(5.4%),无法确定9例(24.3%),术后组织病理阳性3例(8.1%)。术后2周内上肢淋巴水肿发生率对照组88.6%(31/35)、选择组中切除者84.6%(11/13)、选择组中保留者12.5%(3/24);完成6个月随访后水肿发生率对照组31.4%(11/35)、选择组中切除者30.8%(4/13),选择组中保留者未发现上肢淋巴水肿。结论:ARM联合FNAC可安全有效地鉴别上肢淋巴引流,可用于预防ALND后上肢淋巴水肿的发生。
Objective: To investigate the effect of axillary reverse mapping (ARM) combined with fine needle aspiration cytology (FNAC) on the prevention of upper extremity lymphedema in axillary lymph node dissection (ALND) of breast cancer. . Methods: Patients with breast cancer from January 2013 to December 2013 were randomly divided into control group and selective group. All patients underwent ARM and FNAC. The control group resected ARM lymph nodes; if the selected group of ARM lymph nodes as positive, suspicious or uncertain can be removed, the negative is retained. Results: 72 cases of breast cancer, 35 cases of control group and 37 cases of selected group were successfully developed ARM lymph nodes in the axillary region. There were 1 case (2.9%) with fine needle aspiration lymph node in control group, 3 cases (8.6%) suspicious, 6 cases (17.1%) unable to confirm, and 2 cases (5.7% 2 cases were positive (8.1%), 2 cases were suspicious (5.4%), 9 cases (24.3%) were undetermined, and 3 cases were histopathologically positive (8.1%). The incidence of upper extremity lymphedema was 88.6% (31/35) in the 2 weeks after operation, 84.6% (11/13) in the selected group, 12.5% (3/24) in the selected group, and 6 months The incidence of edema in follow-up was 31.4% (11/35) in the control group, 30.8% (4/13) in the resection group, and no upper extremity lymphedema was found in the selected group. Conclusion: ARM combined with FNAC can identify the lymphatic drainage of upper extremities safely and effectively and can be used to prevent upper extremity lymphedema after ALND.