保留肋间臂神经在乳腺癌改良根治术中的应用

Clinical analysis of preserving intercostobrachial nerves in modified radical mastectomy for breast cancer

目的探讨乳腺癌改良根治手术中保留肋间臂神经的意义。方法前瞻性对40例Ⅰ、Ⅱ、Ⅲa期乳腺癌患者进行研究,随机分为试验组和对照组,各20例,所有患者均行改良根治术,其中试验组术保留肋间臂神经,对照组不保留肋间臂神经,比较两组在手术时间、淋巴结清扫数量、术后上臂内侧感觉异常发生率情况。结果两组患者的手术时间、淋巴结清扫数量方面差异无统计学意义。术后1个月时试验组和对照组上臂内侧感觉障碍发生率分别为10.0%与60.0%,差异有统计学意义(掊2=10.99,P=0.003)。结论对Ⅰ、Ⅱ、Ⅲa期乳腺癌患者行乳腺癌改良根治手术时保留肋间臂神经,可明显减少患者术后疼痛综合征,提高生活质量,不增加局部复发及远处转移率。

Objective To investigate the benefits of preserving intercostobrachial nerves （ICBN） in modified radical mastectomy. Methods Forty breast cancer patients （Ⅰ,Ⅱ,Ⅲa） were evenly divided into two groups： the nerves-kept （experimental group） and the nerves-cut （control group）. All patients underwent modified radical mastectomy, taking operative time, detection number of lymph node, postopera- tive paresthesia rate in medial upper arm into consideration. Results There was no statistically signifi- cant difference in the operation time, number of lymph node between the two groups, while postopera- tive paresthesia rate in medial upper arm within one month between the groups showed statistically significance, with 10.0% in experimental group against 60.0% in control group （x^2 = 10.99, P = 0.003）. Conclusion For stage Ⅰ,Ⅱ,Ⅲa breast cancer patients, preserving ICBN can not only reduce suffering from pain syndrome, but also improve patients＇ living qualities, without increasing the incidence of local recurrence and distant metastasis.