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目的 :通过术中鉴别乳腺癌前哨淋巴结 ,以证实乳腺癌在淋巴管播散呈序贯性的假说。方法 :本组 4 5例乳腺癌患者 ,术前 10min用美蓝液 4ml注射到肿瘤周围 ,然后行乳腺癌改良根治术 ,或乳腺区段切除加腋窝淋巴清除术。在切除标本中 ,从原发肿瘤周围先解剖出染色淋巴管 ,然后追寻到第一站引流淋巴结 (前哨淋巴结 )。结果 :在 4 5例乳腺癌患者中成功活检出前哨淋巴结 31例 ,成功率 6 9%。活检出前哨淋巴结平均每例 1.2枚 (0～ 3枚 ) ,清除腋窝淋巴结平均每例 11枚 (范围 6～ 2 3枚 )。 71%病例其前哨淋巴结与腋窝淋巴结性质相符 ,2 9%病例仅为前哨淋巴结阳性。无 1例发生淋巴结跳跃性转移。结论 :①用美蓝染色方法 ,可以活检出前哨淋巴结 ,但其检出率不太理想。有必要与核素扫描等方法结合起来。②本研究证实乳腺癌在淋巴管播散呈序贯性的假说。
Objective: To identify the sentinel lymph nodes of breast cancer through intraoperative operation to confirm the hypothesis that breast cancer is sequential in lymphatic drainage. Methods: Forty-five patients with breast cancer in this group were injected with 4 ml of methylene blue solution around the tumor 10 min before operation, and then modified radical mastectomy or breast segment resection plus axillary lymph node dissection was performed. In resected specimens, stained lymphatic vessels were first dissected from around the primary tumor, and then drained to the first station (sentinel lymph node). Results : 31 cases of sentinel lymph nodes were successfully biopsied in 45 patients with breast cancer. The success rate was 69%. The average number of sentinel lymph nodes was 1.2 (0 to 3), and the average number of axillary lymph nodes was 11 (range, 6 to 23). In 71% of cases, the sentinel lymph nodes were consistent with the nature of axillary lymph nodes, and only 219% of cases were positive for sentinel lymph nodes. No lymph node skipping occurred in 1 patient. Conclusion :1 Sentinel lymph nodes can be biopsied by methylene blue staining, but the detection rate is not ideal. It is necessary to combine methods such as radionuclide scanning. 2 This study confirms the hypothesis that breast cancer is sequential in lymphatic drainage.