探讨乳腺癌腋窝淋巴结清扫术后感觉异常的解剖学机制

Anatomical discussion of paresthesia mechanisms after axillary lymph node dissection in breast cancer

目的为乳腺癌腋窝淋巴结清扫术中预防侧胸壁、腋窝及上臂后内侧感觉异常提供解剖学基础认识。方法解剖30具成人尸体的60侧腋区,观察肋间臂神经(ICBN)及其毗邻关系,详细测量并记录其起源、走行、分支、分布及交通支。结果本组60侧中侧胸壁以第三肋间神经(50侧)和ICBN(29侧)分布为主,未观察到臂内侧皮神经(MBCN)分布至此;腋窝区第三肋间神经、ICBN和MBCN均有分布,但以ICBN分布为主(42侧);上臂后内侧ICBN(42侧)和MBCN(44侧)的分布基本持平,未观察到第三肋间神经分布至此。81.7%(49侧)的ICBN与臂丛存在交通支。63.3%(38侧)的ICBN穿出胸壁时存在伴行血管。结论乳腺癌腋窝淋巴结清除术中找到ICBN及相关神经及其间的交通支,并完整保留,可能更有利于预防患者腋窝淋巴结清扫术后感觉异常的发生。

Objective To provide anatomical basis for preventing paresthesia that appear in the lateral thoracic wall ,the arm‐pit and the inside of the upper arm during axillary lymph node dissection for breast cancer .Methods The intercostobrachial nerve （ICBN） and its contiguous relationship were observed ,besides the origin ,ramus and branch were measured and recorded by anato‐mizing 30 adult embalmed cadavers （60 sides） .Results Three intercostals nerve （50 sides） and the ICBN （29 sides） were the mainly nerves in lateral thoracic wall ,the medical brachial cutaneous nerve（MBCN） was not observed .Three intercostals nerve , ICBN（42 sides）and MBCN（44 sides） were found in armpit ,but mainly was intercostobrachial nerve （42 sides） .ICBN and the MB‐CN equally distributed in the dorsal and medical of the upper arm ,but the three intercostals nerve was not observed .81 .7% （49 sides） of intercostal nerve and all of the brachial plexus presenced filament .They existenced blood vessel accompanied when the ICBN pierced the chest wall （63 .3% ,38 sides） .Conclusion Identify and intactly preserve the ICBN and relevant nerves and their filament during axillary lymph node dissection of the breast cancer may benefit to prevent paresthesia .