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目的总结合并同侧锁骨上淋巴结转移、无远处转移的浸润性乳腺癌患者行锁骨上淋巴结清扫术后的并发症,并探讨该术式的安全性。方法回顾性分析2014年1月至2015年12月期间于笔者所在医院接受锁骨上淋巴结清扫术的98例合并同侧锁骨上淋巴结转移、无远处转移的乳腺癌患者的临床资料。结果本组患者术后同侧上肢迟发型肿胀的发生率为20.4%(20/98),同侧上臂内侧感觉减退和肩关节外展不能完全恢复至术前状态的发生率均为4.1%(4/98),无肩关节外形改变及上臂外展不能情况发生,无头面部水肿、头颈部活动障碍、胸腔积液或乳糜胸发生。78例患者的腋窝及胸壁引流管拔管时间在术后1个月内,18例在术后1~2个月期间,2例在术后2~3个月期间。拔管后有14例(14.3%)再次出现同侧腋窝或胸壁积液。锁骨上引流管拔管时间均在术后3~7 d,中位数为4.5 d,其中3例(3.1%)术后出现乳糜样引流液。结论对于合并同侧锁骨上淋巴结转移、无远处转移的浸润性乳腺癌患者,锁骨上淋巴结清扫术不会导致严重的术后并发症,且无明显影响治疗安全性的因素。
Objective To summarize the complication after supraclavicular lymph node dissection combined with ipsilateral supraclavicular lymph node metastasis and without distant metastasis in patients with invasive breast cancer and to explore the safety of the operation. Methods The clinical data of 98 patients with breast cancer with ipsilateral supraclavicular lymph node metastasis and no distant metastasis who underwent supraclavicular lymph node dissection at the author’s hospital from January 2014 to December 2015 were analyzed retrospectively. Results The incidence of delayed swelling of the ipsilateral upper limb was 20.4% (20/98) in this group. The incidence of ipsilateral upper arm sensory loss and shoulder abduction can not be restored to the preoperative state were 4.1% 4/98), no shoulder shape changes and upper arm abduction can not happen, no head and face edema, head and neck movement disorders, pleural effusion or chylothorax occurred. The extubation time of armpit and chest wall drainage tube in 78 patients was within 1 month after operation, 18 cases were between 1 and 2 months after operation, and 2 cases were between 2 and 3 months after operation. After extubation, 14 cases (14.3%) showed ipsilateral axillary or chest wall effusion again. The duration of extubation of the supraclavicular drainage tube was between 3 and 7 days postoperatively, with a median of 4.5 days. Three cases (3.1%) had chylous drainage after operation. Conclusions For supratentorial supraclavicular lymph node metastases, patients with invasive breast cancer without distant metastases, supraclavicular lymph node dissection does not lead to serious postoperative complications, and no significant factors affect the safety of treatment.