摘要
目的研究影像学检查腋窝阴性的浸润性乳腺癌患者,行染料法腋窝反向淋巴作图(axillary reverse mapping,ARM),探讨影响其成功率的影响因素,并比较保留ARM淋巴结的腋窝淋巴结清扫术(axillary lymph node dissection,ALND)与常规ALND术后上肢淋巴水肿的发生率,分析其危险因素。方法对50例确诊为浸润性乳腺癌,并且术前影像检查腋窝阴性的患者,于术中向患侧上臂内侧皮下及肌肉内注射亚甲蓝染料约2 ml。观察上肢的淋巴管道及淋巴结的显影情况,并对显影的淋巴管道及淋巴结予以保留,比较保留ARM淋巴结的ALND与ARM失败后的ALND术后上肢的淋巴水肿发生率,并且对其潜在因素,如年龄及体质量指数,做正态性检验、t检验及多因素Logistic回归分析。结果 50例中ARM成功的有34例(68%),ARM未成功的有16例(32%)。术中观察保留ARM淋巴结的患者体质量指数及上肢淋巴水肿程度均低于术中ARM失败的患者(P均=0.01),而与年龄无关(P=0.56)。去除混杂因素后的多因素分析表明,术中是否能显示并保留ARM淋巴结,是影响上肢淋巴水肿的独立危险因素(P=0.02,OR=16.39),ARM失败的ALND,术后上肢淋巴水肿发生的危险度是保留ARM淋巴结的ALND的16.4倍。结论乳腺癌术中保留ARM淋巴结,可以有效降低ALND后上肢淋巴水肿的发生。
Objective To investigate the infl uencing factors for the success rate of ARM by blue dying on patients with axillary negative invasive breast cancer detected by imaging examination. The rate of upper limb lymphedema and related risk factors were compared and analyzed after ALND with preserved ARM lymph node and normal ALND. Methods Fifty patients with invasive breast cancer and preoperative axillary negative tested by imaging examination were involved. 2 ml of methylene blue dye was injected into ipsilateral upper extremity subcutaneous and intramuscular during the operation. The developing lymphatic ducts and lymph nodes were observed and preserved. The incidences of postoperative upper extremity lymphedema after ALND with preserved ARM lymph nodes and ALND after the failure of ARM were compared. Some factors, including age and body mass index, were tested by normality test, t test and multivariate logistic regression analysis. Results Thirty-four cases(68%) of ARM(total 50 cases) were successful, while 16 cases(34%) of ARM failed. BMI value and incidence of upper extremity lymphedema in ARM were lower insucceeded patients than that in failed ones(all P =0.01). But the age factor was not associated with ARM succeeded or not(P=0.56). Multivariate analysis after adjusting confounders showed that retention of ARM lymph nodes or not during operation was independent risk factor for upper extremity lymphedema( P=0.02,OR=16.39). The risk of upper extremity lymphedema in ALND with ARM failed was 15.4 times more than that in ARM lymph node preserved ALND. Conclusion Preserving ARM lymph nodes during breast cancer operation could effectively reduce the incidence of upper extremity lymphedema after ALND.
出处
《肿瘤防治研究》
CAS
CSCD
北大核心
2014年第5期452-455,共4页
Cancer Research on Prevention and Treatment
关键词
乳腺癌
腋窝反向淋巴作图
上肢淋巴水肿
Breast cancer
Axillary reverse mapping
Upper extremity lymphedema
