早期乳腺癌腋窝亚LevelⅡ淋巴结清扫的初步研究

目的：探索基层医院早期乳腺癌腋窝淋巴结外科处理的适宜方法。方法：对9例符合研究条件的病例先美兰染色（meythylene blue staining）实施前哨淋巴结活检（sentinel lymph node biopsy,SLNB）,再补充实施腋窝淋巴结清扫术（axillary lymph node dissection,ALND）;ALND术中显露腋静脉,以腋静脉下2cm为界缝线标记,术后将标本从缝线处分离,对淋巴结进行分组取材,将前哨淋巴结、腋静脉下2cm内淋巴结（亚levelⅡ淋巴结）、腋窝其余淋巴结（其余淋巴结）分组送病理检查,观察各组淋巴结数量及肿瘤细胞腋淋巴结转移规律。结果：找到前哨淋巴结6例;5例前哨淋巴结、亚levelⅡ淋巴结、其余淋巴结均为阴性;1例前哨淋巴结、亚levelⅡ淋巴结、其余淋巴结均为阳性;另有1例患者前哨淋巴结未找到,而亚levelⅡ淋巴结检出阳性。结论：基层医院对于早期乳腺癌腋窝淋巴结清扫,可以用美兰染色行前哨淋巴结活检,若前哨淋巴结阳性或未找到前哨淋巴结,行ALND;若前哨淋巴结阴性,行亚levelⅡ淋巴结清扫。

Preliminary study of sub-level-Ⅱaxillery lymph nodes dissection in early-stage of breast cancer

Objective：To explore the proper surgical method for axillery lymphodes treatment in early-stage of breast cancer in grass-roots hospitals.Methods： Nine patients included in this study were peformed meythylene blue staining and sentinel lymph node biopsy（SLNB） followed by supplemental axillary lymph node dissection（ALND）.During the ALND operation,2cm below the axillary vein were marked by suture,by which lymph nodes inside were divided into sub-level Ⅱ group,and other axillary lymph nodes group.After operation,sentinel lymph node,sub-level Ⅱ lymph nodes and other axillary lymph nodes were tested pathologically.Results： Sentinel lymph nodes were found in 6 cases of all patients.Among 5 of these 6 patients,tumor cell was not detected in sentinel lymph node,sub-level II lymph nodes and other lymph nodes,but as to the residual 1 patient,tumor cells were detected in all group of lymph nodes oppositely.Morever,sentinel lymph node was not found in 1 patient with tumor cells detection if sub-level II lymph nodes.Conclusion： In grass-roots hospitals,meythylene blue staining and sentinel lymph node biopsy（SLNB） should be the premier treatment in early-stage of breast cancer.If the sentinel lymph nodes were not found or tumor cells were detected in them,supplemental ALND should be performed.Otherwise,in patients without tumor cells detection in sentinel lymph node,sub-level Ⅱ lymph node dissection may be the better option.