作　　者： (雷涛）; (李振芬）; (冯天恩）; (何亮）; (孔长保）; (李金勇）; (陶青云）; (周永力）; (张慧）; (王文胜）; (李昌盛）;

机构地区： 开封市肿瘤医院肿瘤外科,河南开封475000

出　　处： 《现代肿瘤医学》 2017年第19期3075-3078,共4页

摘　　要： 目的:探讨乳腺癌癌灶区段的淋巴引流途径分型,了解各型淋巴结转移差异。为研究各型乳腺癌的淋巴结转移规律及诊断和治疗方法探索新的思路。方法:收集2006年1月至2016年5月间开封市肿瘤医院行乳腺癌c T_(1-4)N_(0-1)M_0手术的患者,术前对肿瘤所在区段的瘤周腺体注射亚甲蓝,进行淋巴染色示踪,术中见淋巴结或淋巴管染色显示淋巴途径者450例,根据被染色的淋巴管走向和淋巴结尤其是前哨淋巴结(sentinellymph node,SLN)所在区域,进行乳腺癌区段淋巴引流途径分型(lymphatic drainage pathway type,LDPT),分为腋下(axillary,A)型、内乳(internal mammary,IM)型、腋下-内乳(axillary-internal mammary,A-IM)型、锁骨上下(supraclavicular-subciavian,S)型、胸肌间(interpectoral,I)型、上腹(epigastrium type,E)型和其它;其中A型、A-IM型、IM型较为常见,在这三型中选取140例作为对比研究对象,均行经肋间隙入路的内乳区淋巴结(internal mammary lymph nodes,IMLN)探查、腋下淋巴结(axillary lymph nodes,ALN)探查或清扫、保乳或全乳切除,观察比较这三型淋巴结转移情况。结果:LDPT共450例:IM型25例占5.6%、A-IM型75例占16.7%、A型345例占76.7%、S型2例占0.4%、I型2例占0.4%、E型1例占0.2%、其它0例;其中A型、A-IM型、IM型共占98.9%,对比发现:A型、A-IM型、IM型这三型乳腺癌淋巴结转移情况不同,具有显著统计学差异(P<0.01);A型、A-IM型分别与IM型比较,淋巴结转移情况不同,具有统计学差异(P<0.017);IMLN和ALN均转移的概率A-IM型约是A型的5倍,单纯IMLN转移的概率A-IM型约是A型的26倍。结论:不同淋巴分型的乳腺癌淋巴转移规律不同,适合的诊治方法也可能不同,分型研究,具有临床意义;IM型乳腺癌淋巴转移与其他型不同,有其特有的规律,具有与A型同等重要的临床价值,值得关注。 Objective：To investigate the lymphatic drainage path type of the breast cancer section, the differences among various type lymph node metastasis. To explore new ideas for studying the node metastasis law and methods of diagnosis and treatment for various type breast cancer. Methods：The data of operation patients with cT1-4 N0-1M0 breast cancer, performed operations in Kaifeng Tumour Hospital from January 2006 to May 2016 were collected. Methylene blue injection was injected into the peritumoral tissues for lymphatic dye tracer before operation. Lymphatic dyeing of 450 cases showed lymphatic drainage pathway during operation. The lymphatic drainage path type （LDPT） of the breast cancer section was differentiated according to the dyeing lymphatic trend and lymph node especially sentinel lymph node （SLN） location area. According to the lymphatic drainage pathway, the lymphatic drainage pathway type of the breast cancer were divided into axillary （A） type, internal mammary （IM） type, axillary - internal mammary （ A - IM） type, supraclavicular - subciavian （S） type, interpectoral （I） type, epigastrium （E） type, and other type. A type, IM type and A -IM type three are more common, to study compared this three：140 cases were selected as research objects in this three. All underwent breast - conserving surgery or mastectomy with internal mammary lymph node （IMLN） and axillary lymph node （ALN） detection or dissection. Differences were compared between lymph node metastasis. Results： There were 450 cases of breast cancer LDPT ： A type 345 cases accounted for 76.7%, IM type 25 cases accounted for 5.6% ,A - IM type 75 cases accounted for 16.7% ,S type 2 cases accounted for 0.4%, I type 2 cases accounted for 0.4% ,E type 1 case accounted for 0.2% ,and other type 0 case. A type,IM type and A -IM type accounted for 98.9%. Lymphatic metastases had significant different among A type, IM type and A - IM type （P 〈 0.01 ）. A type, A- IM type respectively compared

关 键 词： 乳腺癌 淋巴引流途径 淋巴流域 淋巴分型