保留胸前神经和肋间臂神经的乳腺病灶手术对患者乳房美观的影响

Effects of breast cancer operation with preserving thoracic nerve and intercostobrachial nerve on beautiful outlook of breast

目的研究保留胸前神经和肋间臂神经的乳腺病灶手术对患者乳房美观的影响。方法选择乳腺外科进行治疗的188例乳腺癌患者,按照随机数表法选取94例患者作为观察组,行保留胸前神经和肋间臂神经的乳腺癌改良根治术,选取94例患者作为对照组,行常规乳腺癌改良根治术,比较2组患者在乳腺美观程度、患者治疗满意度上的差异。结果患者手术时间显著高于对照组(t=8.47,P=0.007),出血量差异无统计学意义(t=1.62,P=0.053),患者术后住院时间和切口瘢痕长度等手术基本情况显著低于对照组(P<0.05),术后并发症及肿瘤复发转移发生率上显著低于对照组(P<0.05),观察组乳房美观度平均分显著高于对照组(t=1.77,P=0.039),观察组患者术后满意度较对照组显著增高(χ~2=9.47,P=0.002)。结论保留胸前神经和肋间臂神经的情况下进行乳腺癌改良根治术,对于患者术后感觉功能障碍以及肌肉萎缩存在明显的抑制功能,具有减少手术对于患者乳房美观度的破坏及减少复发转移等优势,值得在临床推广。

Objective To investigate the effects of breast cancer operation with preserving thoracic nerve and intercostobrachial nerve on beautiful outlook of breast. Methods A total of 188 patients with breast cancer who were treated in our hospital from Match 2011 to November 2015 were enrolled in the study. According to random number table method,these patients were divided into observation group（ n = 94） and control group（ n = 94）. The patients in observation group were treated by improved radical mastectomy with preserving thoracic nerve and intercostobrachial nerve,however,the patients in control group were treated by conventional improved radical mastectomy. After operation the esthetic degree of breast,the satisfaction degree of patients,the basic condition of operation,postoperative complications and tumor relapse rate were observed and compared between two groups. Results The operation time in observation group was significantly longer than that in control group（ P〈0. 01）,however,there was no significant difference in intraoperative bleeding volume between two groups（ P〈0. 05）. The incidence rates of postoperative complications including sensory disturbance,axillary pain,upper limb edema and muscle atrophy,and tumor recurrence and metastasis rate in observation group were significantly lower than those in control group（ P〈0. 05）. Moreover the breast aesthetics scores and satisfaction degree of patients after operation in observation group were significantly higher than thoae in control group（ P〈0. 01）. Conclusion The improved radical mastectomy with preserving thoracic nerve and intercostobrachial nerve can improve the postoperative sensory dysfunction and muscular dystrophy,which can relieve the surgical damage on breast beautiful outlook and decrease recurrence and metastasis rate,therefore,which metastasis worthy of promotion in clinical practice.