| Objective:To explore the fat soluble liquid of application value about retaining intercostobrachial nerve, cleaning more lymph nodes and reducing the postoperative complications in the axillary lymph nodes in breast cancer, to evaluate the affection of using the fat dissolving technique in axillary lymph node dissection in obese or locally advanced breast cancer patients.Method:Collecte those clinical pathologic data of all patients, between January 2013 and June 2015, in suzhou, anhui medical university institute of clinical surgical oncology, who were treated with modified radical mastectomy in breast cancer. According to the inclusion criteria and exclusion criteria. Screen that complete clinical pathologic data were 121 cases patients. When cleaning the axillary lymph nodes,60 cases using the traditional way were classified as traditional group, and 61 cases using the fat dissolve, suction operation were classified as Fat-soluble group. Fat-soluble technology:armpit fat capsule were injected fat soluble liquid in front of the axillary dissection for 20 minutes. Absorbed the fat soluble liquid and dissolved in the fat cells. Intraoperative patients ligation of lymphatic and blood vessel, cleaning up the lymph nodes. And protecting the lymphatic vessels of the ipsilateral arm armpits, intercostobrachial nerve, long thoracic nerve and thoracodorsal nerve. All patients followed up to six months. Analysis two groups of differences in operative time, intraoperative blood loss, postoperative hospitalization days, cleaning the lymph node number and total flow rate and the number of days extubation have or not have statistical significance. Compare two groups of postoperative limb upper extremity edema, upper arm of the lateral skin complications such as paralysis of the pain and the shoulder movement disorders. Collect all patients with clinical pathologic data, analysis and comment the lymph node cleaning of using liposoluble technique in different pathological stages, different body mass index, and the size of the lesions.Results:When cleaning the axillary lymph nodes, all of 61 cases of fat soluble group completely retained intercostobrachial nerve, and there are 24 cases in the traditional group of 60 cases failed to retain intercostals arm nerve. Two groups of operating time respectively were (119.7±17.8)minutes and (98.6±16.3)minutes. Peri-operative bleeding respectively were (85.9±15.6)ml and (113.4±13.2)ml, the average hospital stay were (6.3±3.2)days and(11.3±4.8)days, average(22.1±8.4)and(14.2±3.5)removed lymph nodes, total of suction drainage were(265±13.7)ml and(398±14.1)ml, and extubtion time respectively were (5.6±0.3)days and(11.8±1.2)days, upper limb lymph edema 1 case and 8 cases. The upper arm lateral skin paralysis and deadlift disorders were 18 cases and 15 cases in traditional group, and there were 4 cases and 3 cases in fat soluble group. Ruselts in the total of suction drainage, lymph nodes, Peri-operative bleeding, the average hospital stay, extubtion time, the difference was statistically significant (p<0.05). Liposoluble operation time significantly longer than the traditional group, difference was statistically significant(p<0.05).The incidence of upper limb lymph edema and upper arm lateral skin paralysis and dead lift disorders of fat soluble group were less than that of traditional group (p<0.05). Further subgroup analysis results show that the average size of obese patients with fat-soluble cleaning axillary lymph node was average of (22.5±1.6), and achieved good result than the traditional group that was average(15.7±5.5) in cleaning the axillary lymph nodes, the difference was statistically significant (p<0.05). Fat-soluble group of obese patients with operation time was(125.3±10.6)min, non-obese patients with operation time was (119.8±7.8) min, whether obesity of effect of surgery time in fat-soluble group there was no statistically significant difference (p<0.05). Different pathological stages of two groups of cleaning the axillary lymph node number, Ⅱ period respectively was (20.7±1.6) and(13.8±5.9), ⅢA period (T3N1M0) respectively was(21.6±3.5)and (14.7±4.3), two groups of diameter of primary tumor,> 2 cm and< 5 cm,> 5 cm average cleaning number of axillary lymph nodes respectively was(19.8±6.8) and (12.6±5.4),(22.7±5.6) and (13.3±3.2), using fat-soluble surgery for locally advanced breast cancer patients is more meaningful in terms of axillary lymph node cleaning (P<0.05).Conclusion:Fat dissolving technique in the axillary lymph nodes in breast cancer has the following several advantages:1, when cleaning the axillary lymph nodes, application of fat dissolving technique which can provide improved retention intercostobrachial nerve, long thoracic nerve and thoracodorsal nerve, reduce the limb paralysis, upper arm of the lateral skin pain and complications such as shoulder movement disorders.2, when cleaning the axillary lymph nodes, fat soluble liquid can quickly dissolve fat, axillary small lymphatics become better visible, and ligation, it reduces the incidence of limb upper extremity edema caused by postoperative axillary lymphatic leakage.3, Fat soluble liquid dissolve the most fat in armpit and suction, show nodes that hidden in the fat of lymph, and pathology doctor can more quickly, as much as possible to detect lymph node number, and a more accurate axillary lymph nodes can provide important theoretical basis in help clinicians making reasonable treatment and judging prognosis of patients.4, Because fat soluble liquid can quickly dissolve fat, avoid injurying small blood vessels of armpits in traditional intraoperative process using thin shear, reduce the intraoperative blood loss, make more clear operation field and more easy operation.5, Because the fat soluble liquid dissolve adipose capsule within armpit, semi-solid fat was quickly dissolved for liquid, with the gettering of intraoperative negative pressure aspirator, which can reduce the postoperative total flow rate, shorten the tube drawing number, and shorten the length of hospital stay.6, Because axillary fat tissue hypertrophy in the fat breast cancer patients, easily the may have shifted axillary lymph node that hidden in the fat were omissions when they are cleaning lymph nodes, using the fat soluble liquid to dissolve fat fully, improve the lymph node detection rate.7, Using fat soluble liquid with axillary lymph node dissection, obese patients than non-obese patients with no obvious extension in the operation time, due to the nature that fat soluble liquid can quickly dissolve fat, as long as the usage amount within the safe scope was enough, axillary lymph nodes have been could quickly cleaned.8, In fact, the patients who was pathologic stage for Ⅱ,Ⅲ period, primary tumor diameter>2 cm have belonged to local middle-late, more radical lymph node cleaning for them is a great significance for the prognosis of patients, and application of fat soluble liquid can clean more axillary lymph nodes in patients with the class, and more accurate analysis the axillary lymph node status.But fat soluble liquid still have some deficiencies in the axillary lymph node cleaning, the following:When cleaning the axillary lymph nodes, application of fat soluble liquid operating time significantly longer than patients with traditional cleaning methods, this may with the technology in clinical time is shorter, performer operation not skilled, looking forward to further using can shorten the operation time.Fat soluble liquid, therefore, clinical application of the axillary lymph nodes in breast cancer operation do more good than harm, is worth further promotion in the clinical practice. |
PDF Full Text Request