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目的总结乳腺癌腋窝淋巴结解剖术(axillary lymph node dissection,ALND)的手术方法和经验。方法回顾性分析原发性乳腺癌行ALND的169例临床资料。结果本组163例行Ⅰ、Ⅱ平面解剖术,6例行Ⅰ～Ⅲ平面解剖术。切除标本共检出淋巴结4273枚;每例10～69枚,平均(25.28±10.23)枚。术后切口感染3例(1.78%),经引流治愈;患侧上肢水肿4例(2.37%),其中3例为切除Ⅲ平面淋巴结患者,1例为切除Ⅰ、Ⅱ平面淋巴结患者;腋窝淋巴漏1例(0.59%),为切除Ⅲ平面淋巴结病例;患侧上臂内侧及背侧皮肤麻木14例(8.28%),患侧胸肌萎缩5例(2.96%),多发生在先期诊治病例(1999年12月前)或切除Ⅲ平面淋巴结病例。结论ALND要求应用精细解剖技术,切除Ⅰ、Ⅱ平面淋巴结即可,人为扩大手术范围会增加特异性并发症发生率。
Objective To summarize the surgical methods and experience of axillary lymph node dissection (ALND) in breast cancer. Methods A retrospective analysis of 169 cases of primary breast cancer ALND clinical data. Results 163 cases of this group Ⅰ, Ⅱ plane anatomy, 6 cases of Ⅰ ~ Ⅲ plane anatomy. A total of 4273 lymph nodes were detected in the resected specimens, ranging from 10 to 69 in each group with an average of (25.28 ± 10.23) pieces. Three cases (1.78%) were incisional wound infection and were cured by drainage. Four cases (2.37%) of upper extremity edema were involved in the resection. Three cases had resection Ⅲ plane lymph nodes and one case had resection Ⅰ and Ⅱ plane lymph nodes. Axillary lymph leak One case (0.59%) was resected for Ⅲplatform lymph nodes. There were 14 cases (8.28%) in the medial and dorsal upper arms and 5 cases (2.9%) in the ipsilateral chest muscle atrophy, which occurred in the early diagnosis and treatment of cases (1999 12 months ago) or resection of Ⅲ planar lymph node cases. Conclusion ALND requires the use of fine anatomical techniques, resection of Ⅰ, Ⅱ plane lymph nodes can be artificially expanded the scope of the operation will increase the incidence of specific complications.