保留肋骨间神经和胸前神经入路对乳腺癌术后并发症及预后的影响

Impact of retention between the ribs nerve and nerve into the path of postoperative chest complications in patients with breast cancer and prognosis

目的 ：探讨保留肋骨间神经、胸前神经入路对乳腺癌患者术后并发症及预后的影响。方法：选取2011年1月—2013年1月收治的128例I～Ⅱ期乳腺癌患者为研究对象,根据手术方式将患者分为观察组及对照组各64例,观察组患者采用经胸大肌前入路保留肋骨间神经、胸前神经及胸小肌,对照组采用经胸大肌后方入路不保留肋骨间神经及胸小肌,对比分析2组患者手术情况。术后对患者随访1年,观察并发症发生情况,并采用肿瘤生存质量量表（QOL）对患者生存质量进行评价。结果：观察组患者手术时间、术中出血量、引流时间、总引流量、平均住院时间均少于对照组（P〈0.05）。随访1年,观察组皮瓣坏死、皮下积液、蜂窝织炎、胸大肌萎缩、腋窝感觉障碍及上臂内侧感染障碍发生率均低于对照组,差异有统计学意义（P〈0.05）。观察组术后食欲、睡眠、自理能力、心理能力、疾病认识以及总生存质量评分均高于对照组,差异有统计学意义（P〈0.05）。结论：保留肋间臂神经及胸前神经的乳腺癌改良手术能减少患者术中创伤,降低患者术后并发症发生率,提高患者术后生存质量。

Objective： To investigate the impact of retention between the ribs nerve, nerve into the path of postoperative chest complications in patients with breast cancer and prognosis. Meth-ods： 128 cases I ～ II breast cancer patients were divided into observation group（n=64）and control group from January 2011 to January 2013. The observation group patients were treated with premenstrual reserved pectoralis major road between the ribs into the nerve, the nerve and the pectoralis minor chest muscle, the control group were treatmented with retained into the road behind the pectoralis major muscle between the ribs and the pectoralis minor muscle nerves. The surgical conditions of two groups were comparated. Two groups were followed-up after 1 year. The evaluated quality of life of two groups were observed with life scale using tumor（QOL）. Results： The operative time,blood loss, drainage time, total drainage volume, average length of stay of observation group were less than the control group（P〈0.05）. The rates of flap necrosis, seroma, cellulitis, pectoralis major atrophy, sensory disturbances and upper arm axillary barriers inside the incidence of infection of observation group were lower than control group（P〈0.05）. The postoperative observation appetite,sleep, self-care ability, mental ability, disease awareness and overall quality of life scores of observation group were higher than observation group（P〈0.05）. Conclusion： Improved retention of breast cancer and breast surgery ICBN nerve surgery can reduce patient trauma and reduce the incidence of postoperative complications in patients, improve the quality of life patients.