目的

探讨国产纳米炭混悬液对腋窝淋巴结的示踪效果及其安全性。

方法

2008年5月至2009年9月间对21例乳腺癌患者在术前采用纳米炭进行淋巴结示踪。患者年龄30～65岁,平均45.3岁。术前24～72 h于乳晕周围分4点皮下均匀注射纳米炭混悬液共1 ml。手术方式采用改良根治术5例,腔镜下乳房皮下腺体切除、腋窝淋巴结清除加假体植入术12例,乳腺癌局部扩大切除加腔镜腋窝淋巴结清除术4例。术后观察腋窝淋巴结的黑染情况并送病理检查。

结果

21例患者分别检出淋巴结14～32枚,平均每例21.5枚,共452枚。肉眼下黑染淋巴结共435枚,黑染率为96.3%(435/452),其中明显黑染率为85.4%(386/452)。腋窝淋巴结无转移6例,有转移15例。有转移的淋巴结共45枚,均为明显黑染淋巴结,转移淋巴结黑染率为100%。经病理证实,未黑染的淋巴结均未出现癌转移。所有患者经8个月至2年的随访,均未出现复发转移及明显肝肾功能异常。有纳米炭残留的局部组织在术后1年行活组织检查,见乳腺组织间隙有较多的纳米炭颗粒沉集,但未见明显的炎症反应或组织变性。

结论

纳米炭混悬液经乳晕周围皮下注射后24～72 h行腋窝淋巴结清除可达到良好的淋巴结示踪效果,有效避免转移淋巴结的漏检。残留体内的纳米炭无明显的毒副反应。纳米炭是一种安全可靠的腋窝淋巴结示踪剂。

Objective

To explore the dyeing effect and safety of cabon nanoparticles suspension in axillary lymph node dissection of breast cancer.

Methods

From May 2008 to September 2009,21 patients with breast cancer aged 30-65 years(mean,45.3 years)underwent lymphatic tracing with carbon nanoparticles preoperatively. The carbon nanoparticles suspension(1 ml)was subcutaneously injected around the areola at 24-72 hours before operation.Then radical mastectomy in 5 cases,endoscopic subcutaneous mastectomy plus axillary lymph node dissection and immediate reconstruction with implants in 12 cases and breast conserving surgery in 4 cases were performed.After operation,the lymph nodes were dissected and pathologically examined to observe the dyeing status.

Results

The number of blackened lymph nodes ranged from 14 to 32,with a mean of 21.5 per case.The blacking rate under naked eye was 96.3%(435/452),among which obviously blacking rate was 85.4%(386/452).A total of 45 metastatic axillary lymph nodes that were stained obviously black were found in 15 patients,thus the blacking rate of metastatic lymph nodes was 100%.The rest 6 patients showed no metastatic axillary lymph nodes.No black-staining of axillary lymph nodes indicated no metastasis.All patients were followed up for 8 months to 2 years,and no tumor recurrence,metastasis or dysfunction of liver and kidney was found.Carbon nanoparticles deposition was observed microscopically in breast stroma around the injection sites within 1 year after operation,but no inflammatory reaction or tissue degeneration occurred.

Conclusion

A satisfactory effect of lymphatic tracing could be obtained in axillary lymph node dissection at 24-72 hours after the carbon nanoparticles suspension was subcutaneously injected around the areola,and the omission of metastatic lymph nodes could be validly avoided.There was no obviously toxic effect and adverse reaction of residue carbon nanoparticles in vivo.Therefore,carbon nanoparticles suspension is a safe and reliable axillary lymphatic tracer.