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中华乳腺病杂志(电子版) ›› 2017, Vol. 11 ›› Issue (06) : 365 -368. doi: 10.3877/cma.j.issn.1674-0807.2017.06.009

综述

腋窝逆向淋巴示踪的临床实践及争议
刘媛1, 陆云飞1,()   
  1. 1.530021 南宁,广西医科大学第一附属医院胃肠腺体外科
  • 收稿日期:2016-08-09 出版日期:2017-12-01
  • 通信作者: 陆云飞

Clinical practice of axillary reverse mapping and its controversy

Yuan Liu, Yunfei Lu()   

  • Received:2016-08-09 Published:2017-12-01
  • Corresponding author: Yunfei Lu
引用本文:

刘媛, 陆云飞. 腋窝逆向淋巴示踪的临床实践及争议[J/OL]. 中华乳腺病杂志(电子版), 2017, 11(06): 365-368.

Yuan Liu, Yunfei Lu. Clinical practice of axillary reverse mapping and its controversy[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2017, 11(06): 365-368.

前哨淋巴结活组织检查术(SLNB)是腋窝淋巴结阴性乳腺癌患者标准的腋窝处理术式,而腋窝淋巴结清扫术(ALND)则应用于腋窝淋巴结阳性的乳腺癌患者,两者均可能破坏患侧上肢的淋巴回流,从而导致乳腺癌相关淋巴水肿(BCRL),后者在一定程度上降低了患者术后的生活质量。 腋窝逆向淋巴示踪(ARM)旨在通过在SLNB 或ALND 中显示并保留引流上肢淋巴液的淋巴结/淋巴管(ARM LN/LV),以预防BCRL 发生。 然而,将ARM 应用于临床工作前,仍有几个问题亟待解决,如其预防BCRL 的有效性,以及因引流上肢和乳腺的淋巴通道存在交通所致的肿瘤学安全性问题。 近期的研究表明,对于腋窝淋巴结临床阴性、前哨淋巴结(SLN)阳性及SLN 与ARM LN 不重叠的患者而言,ARM在肿瘤学方面是安全的。 淋巴回流通道的重建不仅避免了SLN 与ARM LN 重叠而必须将其切除时所面临的尴尬,而且能有效预防BCRL 的发生。 ARM 作为乳腺癌手术家族中新兴的一员,其应用前景值得期待。

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