保乳手术中保留肋间臂神经的临床研究

Clinical research on preserving intercostobrachial nerve in breast conservation operation

目的探讨乳腺癌保留乳房根治手术(以下简称保乳手术)中腋窝淋巴结清扫时保留肋间臂神经(intercostobraehial nerve,ICBN)的临床意义。方法回顾分析2006年9月至2009年1月开展的46例行保乳手术乳腺癌患者(48个乳房)的临床资料,其中保留ICBN患者26例,未保留ICBN患者22例作为对照进行研究分析,比较两组患者手术中用时、术中出血量、术后患肢感觉变化以及术中清扫淋巴结的数目。结果两组病例术中出血量、清扫淋巴结数目差异无显著性,腋窝淋巴结清扫手术用时、上臂后内侧及腋部皮肤麻木与疼痛感发生率差异具有显著性。结论在0期、Ⅰ期、部分Ⅱa期乳腺癌患者保乳手术中,行腋淋巴结清扫术中保留ICBN是可行的,延长手术时间是可以接受的,不增加出血量,不影响淋巴结清扫,可改善患者术后的感觉障碍(局部麻木与刺痛感),提高生活质量。

Objective To study the clinical value of preserving intercostobrachial nerve（ICBN） in axillary lymphadenectomy for breast cancer during breast conservation operation. Methods From September 2006 to January 2009, 48 breasts of 46 cases of breast cancer were selected for breast conservation surgery. Of in these cases,26 underwent operation with preserving ICBN, and 22 without preserving ICBN as controls. The operation time, the amounts of operation bleeding, sensation of the arm and the number of dissected nodes were compared between the 2 groups. Results Between the two groups, the amount of operation bleeding and the number of dissected nodes had no significant difference, while the difference in the opera- tion time and sensation of the arm was statistically significant. Conclusions In operation for the cases stage of 0-Ⅱ a breast cancer, preservation of ICBN is feasible and leads to a significant decrease in the sensory disturbance of the medial side of upper arm and axilla,without increase in the amounts of operation bleeding and the influence on nodes dissection, the increase in time of operation is acceptable, and the quality of life is improved.