乳腺癌保乳根治术中保留肋间臂神经及胸前神经的临床观察

Clinical Breast Conserving Surgery to Retain ICBN and ATN Observe

目的探讨乳腺癌保乳手术中保留胸前神经(ATN)和肋间臂神经(ICBN)的方法及意义,探讨该术式对患者术后生存质量的影响。方法在以往对Ⅰ期、Ⅱ期乳腺癌患者实施乳腺癌保乳根治术的基础上,进行保留胸前神经和肋间臂神经改良。随机选取了120例Ⅰ、Ⅱ期的女性乳腺癌患者,随机均分为保留组和切除组。结果保留组的胸肌萎缩,上臂后内侧感觉异常和疼痛等不良主诉的发生率较对照组明显降低,二者比较差异有显著性意义(P<0.01);两组间在术中出血量、手术时间及随访期内局部复发及远处转移率上无统计学差异。结论Ⅰ期、Ⅱ期乳腺癌患者行保乳根治术中保留胸前神经及肋间臂神经操作上具有可行性,减少了患者术后疼痛综合征的发生及胸肌萎缩的发生率,提高了患者术后生活质量。

Objective To explore the method and meaning of reserving anterior thoracic nerve （ATN） and the intercostal brachial nerve （ICBN） in breast conserving surgery, and to investigate the effects of the life quality for postoperative patients. Methods 120 patients, who suffered from breast carcinoma （stage Ⅰ or Ⅱ）, were divided into two group： preserving ATN and ICBN or not. All cases were followed up and analyzed. Results For postoperative patients preserving ATN and ICBN, it＆#39;s less to occur pectoral muscle atrophy, paresthesia and pain of the post-medial upper arm, compared to that of patients removing ATN and ICBN （P〈0.01）. However, no statistically difference appeared between two kinds of surgery procedures for local recurrence rate and distant metastasis rate. Conclusions It is a reliable option for the patient with phase Ⅰ and Ⅱ breast cancer to reserve anterior thoracic nerve （ATN） and the intercostal brachial nerve （ICBN） in breast conserving surgery. It could reduce the incidence of postoperative pain syndrome and pectoral muscle atrophy and improve the quality of life.