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目的探讨乳腺癌手术后腋窝淋巴结转移以及不规范性手术后残留实施再手术的可行性。方法制定纳入标准,回顾性分析我院2001年6月至2010年8月间再次腋窝淋巴结清扫手术的36例乳腺癌患者的临床病理资料,再次手术围手术期综合性治疗措施及其术后1、3、5年随访资料。结果全组非规范性手术19例占52.78%(原腋窝残留包块再次清扫11例,胸壁复发包块切除及腋窝淋巴结清扫8例)。原改良根治术11例、Halsted术6例患者术后单纯腋窝复发12例(33.33%),腋窝及胸壁复发性包块5例(13.89%);实施腋窝淋巴结清扫或加胸壁包块切除术。全组病例腋下共检出346枚淋巴结,平均17.78枚(7～35枚),阳性淋巴结58枚占16.76%(1～13枚),部分病例有淋巴结融合。再次手术后均给予4～6疗程化疗或放疗,少数辅以免疫治疗等综合性治疗措施。术后1年内死亡2例,3年内10例,5年15例其1,3,5年生存率分别为94%、72%、58%。结论规范性手术是防止乳腺癌术后复发转移的关键措施,对局部复发、腋窝淋巴结转移可切除患者再次手术有助于控制局部病情的发展,再次手术围手术期规范性治疗可以改善患者的生存质量。
Objective To investigate the feasibility of re-axillary lymph node metastasis after breast cancer surgery and residual operation after non-standard surgery. Methods The standard was established. The clinical and pathological data of 36 patients with breast cancer undergoing axillary lymph node dissection in our hospital from June 2001 to August 2010 were retrospectively analyzed. The perioperative comprehensive treatment measures and the results of postoperative 1 , 3, 5 years follow-up information. Results A total of 19 cases (52.78%) of the non-canonical operation (11 cases of axillary remnants, 11 cases of resection of chest wall and 8 cases of axillary lymph node dissection). Eleven patients underwent modified radical mastectomy and 6 patients underwent Halsted’s surgery. Only 12 cases (33.33%) had simple axillary recurrence and 5 cases (13.89%) had axillary and chest wall recurrent mass. Axillary lymph node dissection or resection of chest wall mass was performed. A total of 346 lymph nodes were detected in the axillary region of the patients, with an average of 17.78 (7 to 35) and 58 positive lymph nodes (16 to 76) (1 to 13). Some cases had lymph node fusion. After surgery were given 4 to 6 courses of chemotherapy or radiotherapy, a small number of supplemented with immunotherapy and other comprehensive treatment measures. There were 2 deaths within 1 year after operation, 10 cases in 3 years and 15 cases in 5 years. The 1, 3, 5 year survival rates were 94%, 72% and 58% respectively. Conclusion Normative operation is the key measure to prevent recurrence and metastasis of breast cancer patients. Surgical resection of axillary lymph node metastasis in resectable patients with axillary lymph node metastasis may help to control the development of local disease. Regurgical perioperative treatment can improve the survival of patients quality.