保留肋间臂神经和胸前神经在乳腺癌改良根治术中的临床意义

Clinical value of preserving pectoral nerve and intercostobrachial nerve during axillary node clearance for breast cancer

目的 探讨保留胸前神经和肋间臂神经在乳腺癌腋淋巴结清扫术中的方法及临床应用价值。方法 2000年3月至2007年3月Ⅰ、Ⅱ、Ⅲa期乳腺癌患者288例，随机分为两组，试验组152例，保留胸前神经和肋间臂神经。对照组136例，切除胸前神经和肋间臂神经。术后对患者上臂内侧感觉功能和胸大肌萎缩度进行随访。结果 试验组患侧上肢感觉异常发生率为39．5％，对照组发生率55．9％，两者相比均有显著性差异（P〈0．01）。术后胸大肌重度萎缩：试验组78例，对照组105例，两组相比均有差异性。结论在Ⅰ、Ⅱ、Ⅲa期乳腺癌改良根治术中施行保留胸前神经和肋间臂神经是可行的，它保存了患侧上臂内侧及腋部皮肤感觉功能和胸大肌的外形，明显减少术后患者上肢感觉障碍和疼痛，提高了患者的生活质量。

Objective To explore the methods and clinical significance of preserving pectoral nerve and intercostobracbial nerve during axillary node dissection for breast cancer. Methods From March 2000 to March 2007,288 cases of stage Ⅰ , Ⅱ , Ⅲa breast cancer patients were divided into experimental group （ n = 152） and control group （ n = 136） respectively. The pectoral nerve and intercostohrachial nerve were preserved in the experimental group and not in control group. Both were followed up after the operation. Results The postoperation morbidity of arm sensory disturbance was 39.5% in the experimental group,which was significantly different from that of the control group（ 55.9% ,x^2 = 17.97 ,P 〈0.01 ）. 78 cases in experimental group and 105 cases in control group suffered from postoperative atrophy of pectoralis major muscles （ P 〈 0.05 ）. Conclusion Pectoral nerve and intercostobraehial nerve preserving modified radical mastectomy prevents pectoralis major muscles from being atrophy, significantly decrease the postoperative morbidity of arm sensory disturbance and pain.