Karakousis C P, Hena M A, Emrich L J, Driscoll D L
Department of Surgical Oncology, New York State Department of Health, Roswell Park Memorial Institute, Buffalo 14263-0002.
Surgery. 1990 Jul;108(1):10-7.
Axillary node dissection was performed in 133 patients with malignant melanoma. The nodes were histologically negative for disease in 67 patients and positive in 66 patients. Disease-free survival rate varied according to the histologic and clinical status of the nodes and to the number of the nodes involved by tumor. The lymphocele rate was 7%; the wound infection rate was 5%; and the skin edge necrosis rate was 0.8%. One patient (0.8%) experienced both lymphocele and wound infection. Neurapraxia developed in the distribution of the musculocutaneous nerve in two patients (2%); this resolved completely in 3 to 4 weeks and was not observed again, since hyperextension of the arm has been carefully avoided during the procedure. Transient arm edema was noted postoperatively in five patients (4%), and the edema responded promptly and completely to elevation of the arm for 1 to 2 weeks. There was no permanent edema even after ligation and resection of the distal portion of the axillary vein (six patients). Permanent arm edema has not developed in any of the 133 patients, indicating that axillary node dissection as performed for malignant melanoma is not associated with the long-term complications occurring after mastectomy and axillary node dissection.
对133例恶性黑色素瘤患者进行了腋窝淋巴结清扫术。组织学检查显示，67例患者的淋巴结无疾病，66例患者的淋巴结有疾病。无病生存率根据淋巴结的组织学和临床状态以及肿瘤累及的淋巴结数量而有所不同。淋巴囊肿发生率为7%；伤口感染率为5%；皮肤边缘坏死率为0.8%。1例患者（0.8%）同时出现淋巴囊肿和伤口感染。2例患者（2%）在肌皮神经分布区域发生神经失用；在3至4周内完全恢复，此后未再出现，因为在手术过程中已小心避免手臂过度伸展。5例患者（4%）术后出现短暂性手臂水肿，将手臂抬高1至2周后水肿迅速完全消退。即使在结扎和切除腋静脉远端部分（6例患者）后，也未出现永久性水肿。133例患者中均未发生永久性手臂水肿，这表明为恶性黑色素瘤进行的腋窝淋巴结清扫术与乳房切除术和腋窝淋巴结清扫术后发生的长期并发症无关。
