研究逆向腋淋巴显影技术(ARM)在乳腺癌患者中的临床运用，分析乳腺癌患者上肢回流淋巴结的分布与转移特点。

前瞻性选择2017年6月至2020年2月期间接受外科手术治疗的乳腺癌女性患者130例，所有患者均行ARM，且均为初次手术者。采用SPSS23.0进行统计学分析。术中上臂直径以(±s)表示，采用t检验；上肢回流淋巴结的转移单因素分析采用χ²检验分析，多因素分析采用Logistic回归分析，P<0.05差异有统计学意义。

122例患者中501枚上肢回流淋巴结追踪成功，成功率为93.8%，A区和B区分别追踪327枚和106枚，共占83.1%，明显高于其他区域(P<0.05)；而上肢回流淋巴结的行走方向以腋静脉、第二肋间臂神经、胸背神经血管束、背阔肌前缘以及前锯肌为界限，主要集中在腋静脉周围；单因素分析显示，患者腋窝淋巴情况、BMI指数、肿瘤分布位置、上臂直径与ARM技术上肢回流淋巴结转移有关(P<0.05)，Logistic回归分析进一步表明，腋窝淋巴情况和肿瘤分布位置是ARM术上肢回流淋巴结转移的独立危险因素。

ARM在乳腺癌手术中可成功定位淋巴结，通过了解淋巴分布位置和行走趋势，可提升淋巴系统保留的完整度，对降低术后淋巴水肿率，提高手术成功率有一定的意义。

To explore the clinical application of reverse axillary lymphography (RAL) for patients with breast cancer and to analyze the distribution and metastasis characteristics of upper extremity lymph nodes.

130 women with breast cancer who underwent primary surgical treatment between June 2017 and February 2020 were prospectively enrolled into the present study. All of them underwent reverse axillary lymphography. Statistical analysis were performed byusing SPSS23.0 software. The upper extremity diameter were expressed as (±s) and were analyzed by using t test. The single-factor analysis of upper extremity reflux lymph node metastasis was analyzed by using 2 test. Multivariate analysis of upper extremity reflux lymph node metastasis was performed by using Logistic regression analysis. A P value of <0.05 was considered as statistically significant difference.

Among the 122 patients, 501 upper extremity reflux lymph nodes were successfully tracked, with A tracking success rate of 93.8%. In A and B regions, there were 327 and 106 tracked lymph nodes respectively, accounting for 83.1%, which was significantly higher than that in other regions (P<0.05). The direction of the upper extremity lymph nodes was along with the axillary vein, the second intercostal brachial nerve, the thoracic dorsal neurovascular bundle, the latissimus dorsi leading edge and the serratus anterior muscle, which were mainly around the axillary vein; Single factor analysis showed that the axillary lymph node status, BMI, tumor distribution location and upper extremity diameter of the patients were related to reflux lymph node metastasis (P<0.05), Logistic regression analysis further showed that the condition of axillary lymph nodes and tumor distribution were independent risk factors for RAL of upper limb reflux lymph node metastasis.

RAL provides a more precise location of upper limb reflux lymph node metastasis, through accurate analysis of the individual's physical condition and understanding of the lymphatic distribution and trend, the integrity of the lymphatic system could be improved, which has certain significance in reducing the rate of postoperative lymphedema and improving the success rate of surgery.