选择性腋窝淋巴结清扫非随机对照研究——70例前瞻性研究.doc

前哨淋巴结活检指导保乳术患者行选择性腋窝淋巴结清扫的研究 陈翔1,2 王水1 刘晓安1 凌立君1 丁强1 査小明1 【摘要】 目的：研究通过前哨淋巴通道（sentinel lymph channel，SLC）(sentinel lymph node biopsy, SLNB)的技术，指导保乳术（breast-conserving therapy，BCT）患者行选择性腋窝淋巴结清扫（axillary lymph node dissection，ALND）的可行性。方法：采用非随机对照研究，在BCT患者中采用联合示踪法通过SLC行SLNB。对术中检取的前哨淋巴结（sentinel lymph node，SLN）行细胞印片和冰冻切片检查，根据SLN的术中病理结果行选择性ALND，其中SLN为阳性，行ALND为A组，SLN为阴性，仅行SLNB为B组。统计数据采用SPSS 10.0分析，比较定性资料选用卡方检验，比较两组均数间的差异采用t检验。结果：2009年1月至2009年12月采用联合示踪法行SLNB的BCT患者共43例，检出42例，A组28例，B组14例。患者均寻及SLC，检出SLN 1~3枚，共59枚，平均1.4枚。SLNB检出率为97.7%（42/43）。共检出阳性SLN 29例。术中细胞印片、冰冻切片和联合病理检测分别检出阳性淋巴结27、27和28例。 A组ALND相关并发症发生率（53.6%）高于B组（7.1%） (P=0.006)。结论：通过SLNB有助于准确定位SLN，能够指导降低并发症axillary lymph node dissection in patients receiving breast-conserving therapy CHEN Xiang, WANG Shui, LIU Xiao-an, LING Li-jun, Ding Qiang, ZHA Xiao-ming Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China Department of General Surgery, The Yixing people’s Hospital , Jiangsu province 214200, China Corresponding author: Zha Xiaoming, Email: zhaxiaoming@ [Abstract] Objective: To study the possibility of selective axillary lymph node dissection (ALND) according to the sentinel lymph node biopsy (SLNB) technique following sentinel lymph channel (SLC) in patients receiving breast-conserving treatment（BCT）. Methods: In this non-randomized study, the SLNB technique with combinative tracer method following SLC was adopted in all patients receiving BTC. All sentinel lymph nodes（SLNs）were investigated by touch cytology and frozen section. According to the intraoperative pathologic results of SLNs, all patients received ALND or SLNB only. Patients in Group A received ALND when the SLNs were positive, patients in Group B received SLNB only in case of negative SLNs. The data were analyzed by SPSS 10.0, Chi-square test was used for comparison of the qualitative data and t test was used to compare the means of the two groups. Results：From Jan. 2009 to Dec. 2009, 43 pat