乳腺癌腋窝淋巴结清扫术中保留肋间臂神经和胸肌神经的方法和临床疗效探讨

To Explore the Technical Note and Clinical Analysis of Intercostobrachial Nerve and Pectoralis Nerve Reservation during Axillary Lymph Node Dissection in Breast Cancer

目的:探讨乳腺癌腋窝淋巴结清扫术中保留肋间臂神经(ICBN)和胸肌神经的方法和临床疗效。方法:选取我院2010年6月-2012年6月行乳腺癌改良根治术患者57例,术中注意保护肋间臂神经和胸肌神经,观察术后患侧腋窝、上臂内侧感觉功能及胸大肌厚度及功能变化。结果:57例患者中46例成功保留肋间臂神经,术后患侧腋窝及上臂内侧感觉正常37例,感觉异常9例,其中感觉减退4例,麻木3例,疼痛2例,另11例因腋窝淋巴结肿大粘连而放弃保留肋间臂神经,术后出现患侧腋窝及上臂内侧感觉异常8例,其中感觉减退5例,麻木2例,疼痛1例。49例成功保留胸肌神经,术后均未出现胸大肌萎缩,8例因胸肌间淋巴结明显肿大粘连放弃保留部分或全部胸肌神经,术后出现轻度胸大肌萎缩1例。结论:乳腺癌腋窝淋巴结清扫术中保留肋间臂神经及胸肌神经可有效避免术后出现患侧腋窝及上臂内侧感觉异常及胸大肌萎缩,改善患者术后生活质量。

Objective ：To explore the technical note and clinical analysis of intercostobrachial nerve （ICBN） and pecto‐ralis nerve reservation during axillary lymph node dissection in breast cancer .Methods ：Pay attention to protect the ICBN and pectoralis nerve During axillary lymph node dissection in 57 patients with breast cancer .To observe the sen‐sory function of the axilla and medical upper arm and the thickness changes and function of pectoralis major of all pa ‐tients after operation .Results ：Among the 57 cases ,46 cases with ICBN reserved ,37 cases had normal sensory function of the axilla and medical upper arm ,9 cases were abnormal ,11 cases with ICBN unreserved ,8 cases were abnormal .49 cases with pectoralis nerve reserved ,the later border thickness changes and the function of pectoralis major had no sig ‐nificant difference compared with before operation .8 cases with pectoralis nerve unreserved ,1 case had signficant differ‐ence compared with before operation .Conclusion ：Reserving ICBN and pectoralis nerve during axillary lymph node dis‐section in breast cancer can effectively avoid the axilla and medial upper arm paresthesia and pectoralis major muscle at ‐rophy after operation .