天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (1): 64-67.doi: 10.11958/20161457

• 临床研究 • 上一篇    下一篇

腋窝逆行淋巴示踪术预防乳腺癌相关水肿的临床可行性分析

孙轩， 殷实， 曹旭晨△ #br# #br#   

  1. 天津医科大学肿瘤医院， 国家肿瘤临床医学研究中心， 天津市 “肿瘤防治” 重点实验室， 乳腺癌防治教育部重点实验室（邮编
    300060）

  • 收稿日期:2016-12-02 修回日期:2016-12-16 出版日期:2017-01-15 发布日期:2017-01-15
  • 通讯作者: 孙轩 E-mail:maidousx@sohu.com
  • 基金资助:
    腋窝逆行淋巴示踪在早中期乳腺癌中的应用

Clinical feasibility of axillary reverse mapping for preventing breast cancer related lymphedema #br# #br#

SUN Xuan, YIN Shi, CAO Xu-chen△ #br# #br#   

  1. Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer,
    Key Laboratory of Cancer Prevention and Therapy, Key Laboratory of Breast Cancer Prevention and
    Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, China

  • Received:2016-12-02 Revised:2016-12-16 Published:2017-01-15 Online:2017-01-15
  • Contact: SUN XUAN E-mail:maidousx@sohu.com

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摘要： 摘要： 目的 明确腋窝逆行淋巴示踪术 （ARM） 中示踪剂注射剂量与上肢淋巴结检出率、 阳性率的相关性及保留 上肢淋巴结对减轻乳腺癌相关水肿的影响。方法 2014 年 1 月—2015 年 6 月就诊于天津医科大学肿瘤医院乳腺 肿瘤一科的 70 例临床分期为 T1~2N0~1M0的乳腺癌患者， 随机分成示踪剂低剂量（0.5 mL）组 40 例与高剂量（2 mL）组 30 例， 对上肢淋巴结进行示踪。切除的上肢淋巴结及腋窝淋巴结均行病理学检查。患者于术前、 术后 6 个月、 12 个 月接受患肢水肿随访。结果 （1）低剂量组和高剂量组的上肢淋巴结检出率分别为 60%（24/40）和 96.7%（29/30）， 差异有统计学意义。（2）摘取 1 枚上肢淋巴结肿瘤阳性率为 4.54%（1/22）， 摘取≥2 枚上肢淋巴肿瘤阳性率为 38.7% （12/31）， 两者差异有统计学意义。但摘取淋巴结＞2 枚时并未能提高病理阳性率 （P=0.717）。（3） 摘取>2 枚上肢淋巴 结患者在随访 6 个月和 12 个月时患肢相对体积变化 （RVC） 明显高于≤2 枚者。结论 增加示踪剂注射剂量可以提 高上肢淋巴结检出率。在 ARM 中摘取 2 枚上肢淋巴结既能准确评估病理状况， 又能最大程度地预防患肢水肿的 发生。

关键词: 乳腺肿瘤, 淋巴结, 淋巴水肿, 腋窝逆行淋巴示踪, 上肢淋巴结

Abstract: Abstract: Objective To investigate the relationship between axillary reverse mapping (ARM), tracer dosage and detection rate of upper lymph nodes, and analyze the feasibility of ARM in preventing breast cancer related lymphedema. Methods Seventy patients diagnosed as T1- 2N0- 1M0 stage and underwent the ARM procedure from January 2014 to June 2015 were enrolled in this study. The patients were divided into low dose tracer group (0.5mL, n=40) and high dose tracer group (2 mL, n=30) randomly. The carbonnano was used as tracer to perform ARM procedure. The ARM lymph nodes and axillary lymph nodes were identified by pathological examination. The limb edema was assessed at 6 and 12 months after the operation by RVC index. Results The detective rates were 60% (24/40) and 96.7% (29/30) in low dose group and high dose group respectively, the difference was statistically significant. Of the 22 patients, the positive rate of removed one upper lymph node was (4.54%), while the metastasis rate was 38.7% in other 31 patients who removed more than two ARM nodes (P<0.05). The metastasis rate of the patients who removed more than two ARM nodes was not increased compared with that of patients removed two ARM nodes (P=0.717). Moreover, after a 12-month follow-up, the relative volume change (RVC) of lymphedema was obviously increased in patients who removed more than two ARM nodes (P < 0.05). Conclusion High dose tracer can increase the detective rate of ARM nodes. The removing two ARM nodes in ARM procedure is recommend, which not only can ensure the pathological diagnosis of node, but also prevent the lymphedema of wounded limb.

Key words: breast neoplasms, lymph nodes, lymphedema, axillary reverse mapping, axillary reverse mapping node