乳腺癌腋清扫术保留肋间臂神经不同解剖途径及成功率

The success rate and the different dissection way of preserving intercostobrachial nerve during axillary node dearante for breast cancer

目的探讨乳腺癌腋淋巴结清扫术保留肋间臂神经（ICBN）的不同解剖途径及成功率。方法选择笔者所在科2005年9月至2008年6月行乳腺癌改良根治术患者136例，随机分为两组：试验组76例术中应用三种解剖途径保留肋间臂神经并统计成功率，对照组60例术中常规切除肋间臂神经。术后对两组患者上臂内侧感觉功能情况进行随访。结果经起始部途径解剖ICBN者39例，误切断3例，成功率为92．30％；经腋静脉下方途径解剖ICBN者18例，误切断2例，成功率为88．89％；经背阔肌途径解剖ICBN者19例，误切断10例，成功率为47．37％；经背阔肌途径与另两组比较差异有显著性（P〈O．01）。试验组患者术后上臂感觉障碍发生率为13．11％（8／61），而对照组为6I．66％（37／60），两组比较差异有显著性（P〈0．01）。结论乳腺癌腋淋巴结清扫术保留肋间臂神经采用经起始部途径和腋静脉下方途径解剖ICBN更方便、安全，保留ICBN成功率更高，可明显减少患者术后患侧上臂内侧感觉障碍的发生率，有助于提高患者的生活质量。

Objective To study the success rate and the different dissection way of preserving intereostobrachial nerve in modified radical mastectomy. Methods Choosing 136cnses about the breast cancer patients with modified radical mastectomy from September 2005 to June 2008 in our department, we randomly divided them into experimental group （ n = 76 ） and control group （n = 60）. The three kinds of dissection ways of preserving intercostobrachial nerve were applied in the experimental group and worked out the success rate. The conventional excision of intercostobrachial arm nerve was applied in the control group. Sensory functions of the medial part of upper arm were examined after the operation. Results There were 39 cases of ICBN dissection by means of dissecting from the beginnlng,and 3 cases of cutting off by mistake, and the success rate is 92.30%. There were 18 cases of ICBN dissection by means of dissecting from the armpit vein underneath, and 2 cases of cutting off by mistake, the success rate is 88.89% ;there were 19 cases ICBN dissection by means of dissecting from the musculus latissimns dorsi,and 10 cases of cutting off by mistake,the success rate is 47.37%. Compared with another two groups, there were significant differences by means of dissecting from the musculns latissimus dorsi （ P 〈 0. 01 ）. The post opelation morbidity of arm sensory disturbance was 13. 11% （8/61） in the experimental group, which was significantly lower than that of the control group 61.66 % （37/60）. The difference between the two groups was significant （ P 〈 0, 01 ）. Conclusion It is more convenient ,safer and higher success rate by adopting the methods of dissecting from the beginning and from the armpit vein underneath in preserving Intercostobrachial Nerve during Axillary Node Clearance for Breast Cancer. For the patients with breast cancer,it can decrease the incidence of sensory disturbance on the skin of medial part of upper arm and can enhance the life quality of the patients after operation.