保留肋间臂神经对乳腺癌腋窝淋巴结清扫术的感觉障碍影响的研究

Effect of intercostobrachial nerve preserving in axillary lymph node dissection on sensory disturbance for breast cancer

目的探讨乳腺癌手术腋窝淋巴结清扫时保留肋间臂神经（ICBN）对感觉障碍影响的研究。方法对146例Ⅰ、Ⅱ、Ⅲa期乳腺癌患者行改良根治术的临床资料进行分析。将其随机分为两组：保留组（67例）行腋窝淋巴结清扫术时保留ICBN，对照组（79例）行腋窝清扫时常规切除ICBN。比较两组在手术时间、腋窝淋巴结清扫数量及术后上臂内侧感觉异常等情况。结果保留组及对照组术后1、3、6个月患侧上臂内侧感觉障碍发生率分别为17．9％、74．9％，11．9％、60．7％，7．4％、59．5％，差异均有统计学意义（x2=46．78，P〈0．001；X2=-36．54，P〈0．001；X2=42．80，P〈O．001）。手术时间及腋窝淋巴结清扫数量差异无统计学意义（P〉0．05）。术后8个月到5年期间随访无局部复发。结论对Ⅰ、Ⅱ、Ⅲa期乳腺癌患者在行腋窝淋巴结清扫时保留ICBN可明显减少术后患侧上臂内侧感觉障碍，从而提高生活质量，不影响局部复发率。

Objective To explore the effect of preserving intercostobrachial nerve （ICBN） in axillary lymph node dissection on sensory disturbance for breast cancer. Methods Clinical data of 146 cases of stage Ⅰ,Ⅱ and Ⅲa breast cancer patients treated by modified radical masteetomy was analyzed. The patients were randomly divided into two groups. Retention group included 67 patients who were performed axillary lymph node dissection preserving ICBN, and 79 cases undergoing axillary lymph node dissection were taken as control group. Data of the two groups were assessed to compare the operation time, number of lymph nodes dissection and sensory abnormalities of upper arms. Results In the follow-up of 1, 3 and 6 months, the incidence rate of the lateral upper arm sensory disturbance were 17.9% and 74.9%, 11.9% and 60.7%, 7.4% and 59.5% respectively in the retention and control group, and the difference was statistically significant （x2=46.78 ,P〈0.001 ;x2=36.54,P〈0.001 ;x2=42.80,P〈0.001）. Meanwhile, there was no obvious difference between the retention and control group in operation time and number of lymph nodes （P〉0.05）. No local recurrence after operation occurred in the follow-up of 8 months to 5 years. Conclusions For stage Ⅰ,Ⅱ and Ⅲa breast cancer patients undergoing axillary lymph node dissection, retaining ICBN can significantly reduce the chance of the postoperative medial upper arm sensory disturbance, improve the quality of life with no increase of local recurrence rate.