摘要
目的评价逆行腋窝淋巴结示踪术(ARM)在乳腺癌手术中的临床可行性及肿瘤安全性。方法系统检索2009年8月1日至2019年8月1日PubMed、Embase、Cochrane library和知网、万方、维普等数据库中关于乳腺癌腋窝手术中使用ARM的研究,根据纳入和排除标准对研究中的上肢淋巴水肿率、淋巴结识别率、臂节交叉率、上肢淋巴结转移率采用Stata 15.0软件进行Meta分析。结果共纳入24篇文献,包括3651例患者,其中随机对照试验研究5篇,前瞻性队列研究19篇。单组率的Meta分析结果显示:在ARM中,腋窝淋巴结清扫术(ALND)上肢淋巴水肿发生率为5%(95%CI 3%~7%),前哨淋巴结活检(SLNB)上肢淋巴水肿发生率为1%(95%CI 1%~2%);SLNB淋巴结/淋巴管识别率为44%(95%CI 34%~54%),ALND淋巴结/淋巴管识别率为83%(95%CI 78%~88%),前哨淋巴结-逆行腋窝淋巴结示踪术臂节交叉率为6%(95%CI 4%~7%);上肢淋巴结转移率为18%(95%CI 13%~23%)。结论ARM能明显降低乳腺癌相关淋巴水肿发生率,但存在上肢淋巴结转移的风险。
Objective To evaluate the clinical feasibility and oncological safety of axillary reverse mapping in breast cancer.Methods Systematic retrieval of Pub Med,Embase,Cochrane library and CNKI,Wan Fang and Vip databases on the use of axillary reverse mapping in breast cancer axillary surgery was performed during Aug.12009 to Aug.12019.According to include and exclude standards in the study for the rate of upper limb lymphedema,Lymph node identification rate,arm crossover rate,upper lymph node metastasis rate using Stata 15.0 software for Meta analysis.Results A total of24 studies,including 3651 patients,including 5 randomized controlled trial studies and 19 prospective cohort studies.Meta analysis results of single group rates showed that in axillary reverse mapping(ARM),the incidence of upper limb lymphedema in axillary lymph node dissection(ALND)was 5%(95%CI 3%-7%),and the incidence of upper limb lymphedema in sentinel lymph node biopsy(SLNB)was 1%(95%CI 1%-2%).The SLNB lymph node/lymphatic identification rate was44%(95%CI 34%-54%),the ALND lymph node/lymphatic identification rate was 83%(95%CI 78%-88%),and the sentinel lymph node-axillary reverse mapping crossover rate was 6%(95%CI 4%-7%).The lymph node metastasis rate was 18%(95%CI 13%-23%).Conclusion Axillary reverse mapping can significantly reduce breast cancer-related lymphedema,but there is a risk of upper limb lymph node metastasis.
作者
张建
余正
王劲松
郭德阳
唐昊
ZHANG Jian;YU Zheng;WANG Jingsong;GUO Deyang;TANG Hao(Department One of General Surgery,Yongchuan Hospital Affiliated to Chongqing Medical University,Chongqing 402160,China)
出处
《医学综述》
2020年第6期1233-1239,共7页
Medical Recapitulate
