乳腺癌改良根治术中保留肋间臂神经的可行性及临床意义

Clinical significance and feasibility of reserving intercostobrachial nerve during modified radical mastectomy

目的探讨保留肋间臂神经(ICBN)在乳腺癌改良根治术中的可行性及临床意义。方法将127例乳腺癌患者随机分为保留组(保留ICBN)67例和切除组(未保留ICBN)60例,所有患者均采用Auchincloss术式,术后均进行12个月随访观察。结果保留组术后1、3、12个月患侧ICBN支配区域感觉异常的发生率均明显低于切除组,差异具有统计学意义(P均<0.05);术后3、12个月患侧ICBN支配区感觉异常面积范围均明显低于切除组,差异具有统计学意义(P均<0.05);术后随访12个月均未见肿瘤腋窝局部复发。结论乳腺癌改良根治术中保留ICBN可以明显降低术后ICBN支配区域皮肤感觉异常发生率,缩小感觉异常面积范围,改善了术后患者的生活质量,具有一定的临床应用价值。

Objective To study the clinical value of preservation of intercostobrachial nerve（ICBN） during modified radical mastectomy.Methods One hundred and twenty seven patients with breast cancer were randomly divided into preservation group（ICBN was preserved）（n = 67 cases） and resection group（ICBN was not preserved）（n = 60 cases）.All patients were treated with Auchincloss surgical procedure and followed up for 12 months.Results At 1,3 and 12 months after surgery,the incidence of sensory abnormality in ICBN dominated region in patients of preservation group was significantly lower than that of patients in resection group,and their difference was significant（P 〈 0.05）.At 3 and 12 months after surgery,the area of sensory abnormality in ICBN dominated region in patients of preservation group was significantly lesser than that of patients in resection group,and their difference was significant（P 〈 0.05）.There was no patient with local axillary recurrence after follow up for 12 months.Conclusion Preservation of ICBN in modified radical mastectomy has the advantages of decreased incidence and area of sensation abnormality,thus it may improve the life quality of patients after surgery.It is worthy for widespread clinical application.