保留胸前神经和肋间臂神经的乳腺癌改良式根治术的疗效

Efficacy of Modified Radical Mastectomy for the Preservation of the Thoracic and Intercostal Brachial Nerves

目的探讨保留胸前神经和肋间臂神经的乳腺癌改良式根治术的疗效。方法将2017年1月—2018年3月可手术、腋窝淋巴结阳性的乳腺癌患者90例作研究对象进行分组。对照组施行不保留胸前神经和肋间臂神经的常规式乳腺癌根治术,观察组施行保留胸前神经和肋间臂神经的改良式乳腺癌根治术。分析比对效果;手术的出血总量、手术之后引流的时间以及引流量;手术前后患者乳腺癌生理评分、社会适应性、整体健康评分;上肢水肿、上臂功能障碍、皮瓣坏死、上肢麻木等的发生率。结果观察组总有效率100.00%高于对照组66.67%,χ~2=7.971,P<0.05,差异有统计学意义。手术后观察组乳腺癌生理评分、社会适应性、整体健康评分(91.24±8.11)分、(93.15±5.16)分、(94.24±3.21)分优于对照组,t值分别是8.214、8.874、7.924,P<0.05,差异有统计学意义。观察组手术的出血总量、手术之后引流的时间以及引流量(143.02±10.12)m L、(5.02±2.02)d、(104.21±11.21)m L优于对照组,t值分别是8.446、9.311、5.766,差异有统计学意义。观察组并发症的发生率6.67%低于对照组22.22%,χ~2=4.939,P<0.05。结论乳腺癌患者行保留胸前神经和肋间臂神经的乳腺癌改良式根治术效果好,可更好改善乳腺癌生理评分、社会适应性、整体健康评分。

Objective To investigate the efficacy of modified radical mastectomy for breast preservation of the thoracic and intercostal brachial nerves.Methods A total of 90 patients with surgically axillary lymph node-positive breast cancer from January 2017 to March 2018 were enrolled in the study.The control group was underwent conventional radical mastectomy without preserving the thoracic and intercostal brachial nerves.The observation group was underwent modified radical mastectomy that preserved the thoracic and intercostal brachial nerves.Analyze the comparison effect;the total amount of bleeding after surgery,the time and amount of drainage after surgery;the physiological score,social adaptability and overall health score of breast cancer before and after surgery;incidence of upper extremity edema,upper arm dysfunction,skin flap necrosis,upper limb numbness,etc.Results The total effect of the observation group was 100%higher than that of the control group(66.67%),χ~2=7.971,P<0.05,the difference was statistically significant.Postoperatively,the breast cancer physiological score,social adaptability,and overall health scores were(91.24±8.11)points,(93.15±5.16)points,and(94.24±3.21)points,which were superior to the control group,t values were 8.214,8.874 and 7.924 respectively,P<0.05,the difference was statistically significant.The total amount of bleeding in the observation group,the time of drainage after surgery,and the amount of(143.02±10.12)mL,(5.02±2.02)d,(104.21±11.21)mL were better than the control group,t values were 8.446,9.311,5.766 respectively,P<0.05,the difference was statistically significant.The incidence of complications was 6.67%lower than 22.22%in the control group,χ~2=4.939,P<0.05,the difference was statistically significant.Conclusion Breast cancer patients with improved pre-thoracic nerve and intercostobrachial nerve for improved radical mastectomy have better effects,which can improve breast cancer physiological score,social adaptability and overall health score.