乳腺癌腔镜下腋窝淋巴结清扫保留肋间臂神经的临床研究

The clinical research of the preservation of the intercostobrachial nerve during axillary lymph node dissection of breast cancer by endoscope surgery

目的探讨乳腺癌腔镜下腋窝淋巴结清扫（EALND）术中保留肋间臂神经的临床可行性。方法选取2010年1月至2012年1月间收治的65例行EALND的Ⅰ、Ⅱ期乳腺癌患者进行回顾性分析，按是否保留肋间臂神经分为观察组（保留肋间臂神经，48例）和对照组（未保留肋间臂神经，17例）。观察并对比两组的手术时间、术后上臂内侧和腋窝皮肤的感觉情况。结果观察组与对照组平均手术时间分别为（89．3±28．1）min及（90．2±26．9）min，差异无统计学意义（P〉0．05）；观察组与对照组术后上臂内侧和腋窝皮肤感觉异常者分别为5例（10．4％）及13例（76．5％），差异有统计学意义（P〈0．01）。所有患者术后随访12～37个月，平均随访27个月，未发现切口种植转移及肿瘤复发。结论早期乳腺癌患者行EALND保留肋间臂神经具有临床可行性，并具有较大的临床价值。

Objective To explore the clinical feasibility of the preservation of the intercostobrachial nerve during axillary lymph node dissection （EALND） of breast cancer by endoscope surgery. Methods Retrospectively analyzed 65 cases with stage l, stage H breast cancer who underwent EALND in hospital from January 2010 to January 2012. Patients were divided into observation group （48 cases） and control group （17 cases） according to whether preserve the intercostobrachial nerve. The operation time, the postoperative skin feeling of medial upper arm and axillary of the two groups were compared. Results The average operation time of observation group and control group were （ 89. 3 ± 28.1 ） min and （90. 2 ± 26. 9 ） min respectively, and there was no significant difference between the two groups （P 〉 0. 05 ）. The postoperative unusual skin feeling of medial upper ann and axillary of the experimental group and control group respectively turned out to be 5 cases （ 10. 4% ） and 13 cases （76. 5% ） ,and the difference was significant （P 〈0. 01 ）. All cases were followed up for 12 -37 months postoperatively （average follow-up time 27 months）. No incision metastasis and tumor recurrence were found. Conclusions The Preservation of the intereostobrachial nerve in EALND is feasible in early period of breast cancer, and it deserve further clinical application.