Clinical application of axillary adjacent tissue flap in axillary lymph node dissection of breast cancer

doi:10.3877/cma.j.issn.1674-0807.2017.04.004

Abstract

Abstract:

Objective

To investigate the clinical application of axillary peripheral tissue flap during axillary lymph node dissection for breast cancer patients.

Methods

This prospective study involved the clinical data of totally 86 patients with invasive ductal breast cancer who underwent axillary lymph node dissection in Department of Thyroid and Breast Surgery, First People's Hospital of Jingmen City, Hubei Province from March 2014 to March 2015. Forty-one patients were surgically treated with axillary peripheral tissue flap as study group and the remaining 45 patients received no immediate surgical repair as control group. The drainage time,drainage volume, the extent of upper limb dysfunction and patients' satisfaction with axillary appearance and comfort degree were recorded in two groups. Multiple-frequency bioelectrical impedance analysis system was used to determine the ratio of extracellular water to intracellular water in healthy and affected limbs(ECW_d/ICW_d) so as to reflect the incidence of upper limb lymphedema in postoperative 1 year. The parameters including age, body mass index, number of dissected lymph nodes, number of positive lymph nodes, drainage volume and drainage time, upper limb dysfunction, patients' satisfaction with axillary appearance and comfort degree, and ECW_d/ICW_d between two groups were compared using t test. The number of lymphatic fistula patients was compared between two groups using χ² test. Postoperative pathological stage was compared between two groups using rank sum test.

Results

There were no significant differences in age,body mass index, number of dissected lymph nodes, number of positive lymph nodes and postoperative pathological stage between 2 groups (t=-0.216,0.625, -0.504, -0.796, Z=-0.459; P=0.830, 0.534,0.615,0.428,0.647). The drainage volume and drainage time in study group were significantly lower than those in control group [(408.95±49.18) ml vs (458.60±53.88) ml, t=-4.448,P＜0.001; (6.49±1.16) d vs (7.11±1.15) d, t=-2.493, P=0.015]. The incidence of lymphatic fistula was 9.76% (4/41) in study group,significantly lower than that in control group (28.9%,13/45) (χ²=4.952,P=0.026). The extent of upper limb dysfunction in study group was significantly lower than that in control group [(3.37±0.69)% vs(3.71±0.81)%, t=-2.099, P=0.039]. The patients' satisfaction with axillary appearance and comfort degree,and ECW_d/ICW_d in study group were superior to those in control group (7.88±0.90 vs 7.20±0.96,t=3.355, P=0.001;6.98±0.82 vs 6.18±0.80,t=4.544, P＜0.001; 1.83±0.21 vs 1.94±0.22,t=-2.257,P=0.027).

Conclusion

The immediate surgical repair using axillary peripheral tissue flap during axillary lymph node dissection can effectively avoid lymphatic fistula, ameliorate upper limb function, improve axillary appearance and comfort and prevent upper limb lymphedema.

Key words: Breast neoplasms, Lymph node excision, Lymphedema, Surgical flaps, Upper extremity

Min Jia, Guangxiong Xiao. Clinical application of axillary adjacent tissue flap in axillary lymph node dissection of breast cancer[J]. Chinese Journal of Breast Disease(Electronic Edition), 2017, 11(04): 208-212.

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Figures/Tables 5

指标	年龄(岁, $\bar{x}$ ±s)	体质指数(kg/m², $\bar{x}$ ±s)	淋巴结清扫数目(枚, $\bar{x}$ ±s)	淋巴结阳性数目(枚, $\bar{x}$ ±s)	病理分期(例)
指标	年龄(岁, $\bar{x}$ ±s)	体质指数(kg/m², $\bar{x}$ ±s)	淋巴结清扫数目(枚, $\bar{x}$ ±s)	淋巴结阳性数目(枚, $\bar{x}$ ±s)	Ⅰ	Ⅱ	ⅢA	ⅢB	ⅢC
研究组(n=41)	48.76±8.22	24.25±2.79	19.59±4.36	0.80±1.26	11	23	7^a	0	0
对照组(n=45)	49.16±8.89	23.85±3.08	20.09±4.84	1.11±2.14	10	27	6^b	1^c	1
检验值	t=-0.216	t=0.625	t=-0.504	t=-0.796	Z=-0.459
P值	0.830	0.534	0.615	0.428	0.647

指标	年龄(岁, $\bar{x}$ ±s)	体质指数(kg/m², $\bar{x}$ ±s)	淋巴结清扫数目(枚, $\bar{x}$ ±s)	淋巴结阳性数目(枚, $\bar{x}$ ±s)	病理分期(例)
指标	年龄(岁, $\bar{x}$ ±s)	体质指数(kg/m², $\bar{x}$ ±s)	淋巴结清扫数目(枚, $\bar{x}$ ±s)	淋巴结阳性数目(枚, $\bar{x}$ ±s)	Ⅰ	Ⅱ	ⅢA	ⅢB	ⅢC
研究组(n=41)	48.76±8.22	24.25±2.79	19.59±4.36	0.80±1.26	11	23	7^a	0	0
对照组(n=45)	49.16±8.89	23.85±3.08	20.09±4.84	1.11±2.14	10	27	6^b	1^c	1
检验值	t=-0.216	t=0.625	t=-0.504	t=-0.796	Z=-0.459
P值	0.830	0.534	0.615	0.428	0.647

术后监测指标	引流量(ml, $\bar{x}$ ±s)	引流时间(d, $\bar{x}$ ±s)	淋巴瘘[例(%)]	上肢功能障碍程度(%, $\bar{x}$ ±s)	腋窝外形满意度评分(分, $\bar{x}$ ±s)	腋窝舒适度评分(分, $\bar{x}$ ±s)	ECW_d/ICW_d( $\bar{x}$ ±s)
研究组(n=41)	408.95±49.18	6.49±1.16	4(9.76)	3.37±0.69	7.88±0.90	6.98±0.82	1.83±0.21
对照组(n=45)	458.60±53.88	7.11±1.15	13(28.9)	3.71±0.81	7.20±0.96	6.18±0.80	1.94±0.22
检验值	t=-4.448	t=-2.493	χ²=4.952	t=-2.099	t=3.355	t=4.544	t=-2.257
P值	＜0.001	0.015	0.026	0.039	0.001	＜0.001	0.027

术后监测指标	引流量(ml, $\bar{x}$ ±s)	引流时间(d, $\bar{x}$ ±s)	淋巴瘘[例(%)]	上肢功能障碍程度(%, $\bar{x}$ ±s)	腋窝外形满意度评分(分, $\bar{x}$ ±s)	腋窝舒适度评分(分, $\bar{x}$ ±s)	ECW_d/ICW_d( $\bar{x}$ ±s)
研究组(n=41)	408.95±49.18	6.49±1.16	4(9.76)	3.37±0.69	7.88±0.90	6.98±0.82	1.83±0.21
对照组(n=45)	458.60±53.88	7.11±1.15	13(28.9)	3.71±0.81	7.20±0.96	6.18±0.80	1.94±0.22
检验值	t=-4.448	t=-2.493	χ²=4.952	t=-2.099	t=3.355	t=4.544	t=-2.257
P值	＜0.001	0.015	0.026	0.039	0.001	＜0.001	0.027

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