乳腺前哨淋巴结的诊断活检

R. Nikitenko, E. Koichev, S. P. Degtyarenko
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摘要

目标。目的:提高对乳腺癌患者前哨淋巴结的诊断活检,应用荧光淋巴造影,减少术后并发症的发生。材料和方法。2016年至2021年期间,在敖德萨地区临床医院的基础上,400例患有Т1 -Т3N0М0期乳腺癌的患者应用荧光淋巴造影进行了手术,使用了两种染料-专利蓝和吲哚菁绿。所有患者分为两组。第一组(对照组)200例患者行前哨淋巴结活检。淋巴结染色采用染蓝染色。在第二组(主要)200名女性患者中,使用专利蓝和荧光染料吲哚菁绿进行前哨淋巴结活检。两种染色剂沿外乳晕边缘皮下注射剂量为2毫升的染色剂溶液。结果。腋窝淋巴清扫和前哨淋巴结活检的5年总生存率分别为91%和92%,无复发5年生存率分别为82.2%和83.9%。受影响乳腺侧前哨淋巴结的局部复发在女性患者中占1.1%。在58%的女性患者中前哨淋巴结是清晰的,这就是为什么后续的淋巴清扫没有被指示进行的原因。42%的女性患者出现转移性淋巴结。结论。使用染色剂对乳腺癌前哨淋巴结进行诊断活检的方法,使大多数患者放弃了创伤性手术,而采用了保留器官的干预措施,从而大大降低了术后并发症的发生率。
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Diagnostic biopsy of sentinel lymph nodes in mammary gland cancer
Objective.To improve the diagnostic biopsy of sentinel lymph nodes in patients, suffering mammary gland cancer, using fluorescent lymphography, and to reduce the quantity of postoperative complications. Materials and methods. In 2016 – 2021yrs period on the base of Odessa Regional Clinical Hospital 400 patients, suffering mammary gland cancer Stages Т1–Т3N0М0, were operated on with application of fluorescent lymphography, using two dyers – the patent blue and indocyanine green. All the patients were distributed into two groups. In Group I (a control one) in 200 patients the sentinel lymph nodes biopsy was performed. The dyer patent blue was applied for the lymph nodes coloring.In Group II (the main) in 200 women–patients the sentinel lymph nodes biopsy, using the patent blue and fluorescent dyer indocyanine green, was performed. Both dyers were injected subdermally along the external areolar edge in the dose 2 ml of the dyer solution. Results. Total 5–year survival after axillary lymphodissection and after the sentinel lymph node biopsy have constituted 91and 92%, accordingly, while the recurrence–free 5–year survival – 82.2 and 83.9%, accordingly. Regional recurrence in sentinel lymph nodes on the affected mammary gland side was diagnosed in 1.1% of the women–patients. In 58% of the women–patients the sentinel lymph nodes were clear, and that’s why a subsequent lymphodissection was not indicated to perform. Metastatic lymph nodes were revealed in 42% of the women–patients. Conclusion. The method of diagnostic biopsy of sentinel lymph nodes in patients, suffering mammary gland cancer, using dyers, permits in majority of them to abandon traumatic operations in favor of organ–preserving interventions, thus reducing the postoperative complications rate significantly.
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