乳腺癌腋清扫术不同解剖途径对保留肋间臂神经成功率的影响

Success rates of the different dissection way of preserving intercostobrachial nerve during axillary node clearance for breast cancer

目的探讨乳腺癌腋清扫术不同解剖途径对保留肋间臂神经(ICBN)成功率的影响。方法选择该科2005年9月～2009年9月行乳腺癌改良根治术的患者98例,术中应用3种解剖途径保留ICBN并统计成功率。成功保留ICBN的77例者为实验组,术中误切断和其他原因无法保留ICBN的66例作为常规切除者入选对照组,进行患侧上臂内侧感觉异常的比较。结果经起始部途径解剖ICBN 39例,误切断3例,成功率为92.30%,经腋静脉下方途径解剖ICBN 30例,误切断4例,成功率为86.67%,经背阔肌途径解剖ICBN 29例,误切断14例,成功率为51.72%。经背阔肌途径与另外两种途径比较,成功率的差异有显著性(P<0.01)。实验组患者术后上臂感觉障碍发生率为15.58%(12/77),而对照组为57.58%(38/66),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ICBN采用经起始部途径和腋静脉下方途径解剖更方便、更安全,保留ICBN的成功率更高;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 of different dissection way of preserving intercostobrachial nerve in modified radical mastectomy.【Methods】 98 cases of breast cancer patients with modified radical mastectomy from September 2005 to September 2009 in our department were collected,the three kinds of dissection ways of preserving ICBN in the operation were taken and the success rate was calculated.77 cases which can reserve ICBN successfully is the experimental group,and 66 cases as the conventional excision cases which can not reserve ICBN because of the cutting by mistake in the operation and other reasons.【Results】 There were 39 cases of ICBN dissection by means of dissecting from the beginning,and 3 cases of cutting off by mistake,and the success rate was 92.30%;there were 30 cases of ICBN dissection by means of dissecting from the armpit vein underneath,and 4 cases of cutting off by mistake,the success rate was 86.67%;there were 29 cases ICBN dissection by means of dissecting from the musculus latissimus dorsi,and 14 cases of cutting off by mistake,the success rate was 51.72%.Compared with the other two groups,there were significant differences by means of dissecting from the musculus latissimus dorsi（P 0.01）.The post operation morbidity of arm sensory disturbance was 15.58%（12/77） in the experimental group,which was significantly lower than that of the control group 57.58%（38/66）.The difference between the two groups was satistically significant（P 0.01）.【Conclusion】 It is more convenient,safer and the higher success rate by adopting the methods of dissecting from the beginning and from the armpit vein underneath in preserving ICBN 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.