保留肋间臂神经在乳腺癌改良根治术中的应用

The application value of preserving intercostobrachial nerve in modified radical mastectomy

目的:探讨保留肋间臂神经(intercostobrachial nerve,ICBN)在乳腺癌根治术中的应用及临床价值。方法:选定83例行乳腺癌改良根治术患者,其中观察组患者41例(术中保留ICBN),对照组42例(术中切除ICBN)。所有患者术后随访观察3个月至3年,比较2组患者手术操作时间、淋巴结清扫数目、术后感觉异常发生率、患肢淋巴水肿发生率和肿瘤局部复发率之间的差异。结果:观察组平均手术时间(113.56±5.78)min,淋巴结平均清扫数目为(12.28±2.19)枚,患肢淋巴水肿3例;对照组平均手术时间为(110.17±5.41)min,淋巴结平均清扫数目为(12.83±2.13)枚,患肢淋巴水肿2例;2组患者手术时长、淋巴结清扫数目和患肢淋巴水肿差异均无统计学意义(P>0.0.5)。观察组术后皮肤感觉异常发生率为21.95%,明显低于对照组的66.67%(P<0.05)。2组患者术后随访期间均未发现肿瘤局部复发。结论:乳腺癌改良根治术中清扫腋窝淋巴结时,予以保留ICBN可明显减少术后患侧胸壁和上臂内侧感觉异常的发生率,值得推广。

Objective： To investigate the clinical value of preserving intercostobrachial nerve（ ICBN） in modified radical mastectomy.Methods： Eighty-three breast cancer patients treated with modified radical mastectomy were divided into the observation group（ 41 cases treated with preserving ICBN） and control group（ 42 cases treated without preserving ICBN）. All patients were followed up for 3 months to 3 years. The operation time,number of dissecting lymph nodes,indicence rate of sensory dysfunction,limb lymphedema rate and local recurrence rate between two groups were compared. Results： The mean operation time and number of dissecting lymph nodes in observation group were（ 113. 56 ± 5. 78） min and（ 12. 28 ± 2. 19）,respectively. The mean operation time and number of dissecting lymph nodes in control group were（ 110. 17 ± 5. 41） min and（ 12. 83 ± 2. 13）,respectively. The differences of the operation time,number of dissecting lymph nodes and limb lymphedema rate between two groups were not statistically significant（ P〉0. 05）. The postoperative sensory dysfunction rates in observation group and control group were 21. 95% and 66. 67%,respectivly,the difference of which between two groups was statistically significant（ P〈0. 05）. The local recurrence of tumor in two groups was not found during the following-up. Conclusions： During dissecting axillary lymph nodes in modified radical mastectomy,preserving ICBN can obviously decrease the incidence rate of sensory dysfunction in ipsilateral medial upper arm and chest wall,which is worthy of promoting.