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目的:探讨乳腺外侧癌首先行腋窝淋巴结清扫的价值。方法:35例乳腺外侧癌患者采用首先清扫腋窝淋巴结,阻断胸外侧动静脉,后切除乳腺的手术方法。结果:全组无手术死亡、血管及神经损伤。术中2例输血4U,3例输血2 U,34例术后血红蛋白下降1~39g/L,皮缘坏死3例,皮下积液1例,皮肤延迟愈合1例,患肢轻度淋巴水肿4例,伤口局部癌复发1例。15例术中腋窝未及肿大淋巴结者,病理报告2例淋巴结转移,未行锁骨下淋巴结清扫。20例腋窝可及肿大淋巴结者,行腋窝及锁骨下淋巴结清扫,病理证实14例腋窝转移,6例锁骨下淋巴结转移。经1~4年随访,死亡1例,失访9例,存活25例,复发1例。结论:乳腺外侧癌,首先经腋窝清扫是安全的,关键是腋鞘定位,并根据腋窝淋巴结有无转移决定是否行锁骨下淋巴结清扫,阻止经淋巴管及静脉的癌细胞转移。
Objective: To investigate the value of axillary lymph node dissection in lateral breast cancer. Methods: Thirty-five patients with lateral breast cancer were treated by first dissecting the axillary lymph nodes, blocking the lateral thoracic arteries and veins, then resecting the breast. Results: There was no operative death, blood vessel and nerve injury in the whole group. 2 transfusions were performed in 4 patients and 3 transfusions were performed in 2 U patients. 34 patients had postoperative hemoglobin decrease of 1 to 39g / L, 3 skin necrosis, 1 skin subsidence, 1 skin delayed union and mild lymphedema 4 For example, 1 case of local cancer recurrence. 15 cases of axillary lymph nodes were not enlarged, 2 cases of pathological lymph node metastasis, not undergoing subclavian lymph node dissection. 20 cases of axillary lymph nodes and axillary lymph nodes and subclavian lymph node dissection, pathology confirmed 14 cases of axillary metastases, 6 cases of subclavian lymph node metastasis. After 1 to 4 years follow-up, 1 patient died, 9 patients lost to follow-up, 25 patients survived and 1 patient relapsed. Conclusion: The extramammary breast cancer is safe to be cleared by axillary first. The key point is the positioning of axillary sheath. According to the metastasis of axillary lymph nodes, whether to perform subclavian lymph node dissection or not is to prevent the metastasis of lymphatic vessels and vein cancer cells.