目的：探讨前哨淋巴结（sentinel lymph node, SLN）阴性乳腺癌病人腋窝低位淋巴结清扫的必要性和安全性。方法：纳入2015年1月至2017年1月本中心及上海交通大学医学院附属瑞金医院外科乳腺疾病诊治中心单纯乳房切除和SLN阴性的718例乳腺癌病人,均行腋窝低位淋巴结清扫,分析其转移率及转移相关因素。结果：本研究腋窝低位淋巴结检出686例（95.5%）,平均检出（9.4±5.7）（0~21）枚。40例病人发现腋窝低位淋巴结转移,转移率5.6%（40/718）。单因素分析显示,腋窝低位淋巴结转移与腋窝淋巴结可触及、前哨淋巴结活检（sentinel lymph node biopsy, SLNB）数目、脉管癌栓、神经侵犯、HER2阳性、分子分型显著相关（P<0.05）。多因素Logistic分析显示,腋窝淋巴结可触及、SLNB数目、脉管癌栓、神经侵犯、分子分型是腋窝低位淋巴结转移的独立危险因素。术后患肢发生上肢淋巴水肿5例（0.7%）,病人上肢功能恢复良好。结论：SLN阴性乳腺癌病人存在腋窝低位淋巴结临床转移。腋窝低位淋巴结转移存在许多危险因素,有必要行淋巴结清扫。
Objective To study lower axillary lymph node dissection in patients of breast cancer with negative sentinel lymph node (SLN). Methods From January 2015 to January 2017, a total of 718 patients of breast cancer with negative SLN had mastectomy and lower axillary lymph node dissection in both our department and Department of Surgery Comprehensive Breast Health Center Ruijin Hospital Shanghai Jiao Tong University School of Medicine. Metastasis rate of lower axillary lymph node and the factors related to metastasis were analyzed. Results Lower axillary lymph node was identified in 686 cases (95.5%) with (9.35±5.684) (0~21) lymph node per patients on average. Metastasis to lower axillary lymph nodes was found in 40 patients (5.6%, 40/718). Single-variant analysis showed that metastasis of lower axillary lymph nodes was related to enlarged axillary lymph nodes, number of SLN biopsy, tumor vascular thrombus, nerve invasion, HER2 positive, and molecular classification (P<0.05). Independent risk factors associated with lower axillary lymph node metastasis were shown in multivariate Logistic analysis including enlarged axillary lymph nodes, number of SLN biopsy, tumor vascular thrombus, nerve invasion, and molecular classification. There were 5 (0.7%) cases with postoperative upper limb lymphedema, and upper limb dysfunction was not found. Conclusions Metastasis of lower axillary lymph node was present combined with multiple risk factors in the patients of breast cancer with negative SLN and should be dissected.
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