保留肋间臂神经在乳腺癌改良根治手术中的应用

Preservation of intercostobrachial nerves in axillary lymph node dissection for breast cancer

目的探讨乳腺癌改良根治手术中保留肋间臂神经的可行性和方法。方法乳腺癌患者78例,其中49例在改良根治术中保留肋间臂神经,29例未保留肋间臂神经。结果49例保留肋间臂神经的患者中,46例术后腋窝及上臂感觉良好,3例出现感觉障碍,但在短时间内恢复。未保留肋间臂神经的29例患者均出现不同程度的腋窝及上臂感觉障碍。经随访无1例出现局部复发。结论乳腺癌改良根治术中保留肋间臂神经可以预防术后腋窝及上臂感觉障碍的发生,不增加局部复发的风险,应成为乳腺癌改良根治手术的标准组成部分。

Objective To explore the feasibility and clinical value of preserving intercostobrachial nerve （ ICBN ） in axillary lymph node dissection for female primary breast cancer. Methods Preservation of ICBN in axillary lymph node dissection was performed between the year 2002 to 2005 in 78 patients with stage Ⅰ or Ⅱ breast carcinoma. ICBN was preserved completely in 49 cases,and dissected in 29 cases. All patients were followed up after operations. Results Among the 49 patients with ICBN preserved,46 patients （93.8%） had normal sensation of the skin of uppermedial arm and axilla, while paresthesia occurred in 3 cases （ 6.2% ）. By contrast, all patients with ICBN dissected had paresthesia. No local failure occurred. Conclusion It is feasible to preserve ICBN in axillary lymph node dissection for stage Ⅰ or Ⅱ breast carcinoma. The normal sensory functions of the skin of upper medial ann and axilla are conserved and the life quality of the patients is improved after modified radical operations.