乳腺癌手术中保留胸前神经、肋间臂神经的临床意义

Clinical significance of preserving anterior thoracic nerve and intercostal brachial nerve in radical mastectomy

目的探讨乳腺癌手术中保留胸前神经、肋间臂神经的临床意义及其对患者的影响。方法回顾性分析我院2012年1月至2015年5月收治的58例乳腺癌患者的临床资料,患者均行乳腺癌根治手术治疗,将保留胸前神经及肋间臂神经的31例设为A组,切断胸前神经及肋间臂神经的27例设为B组。比较两组患者3年无病生存率、术后胸肌萎缩、感觉异常及肿瘤转移发生情况。结果 A组患者3年无病生存率为58.06%,与B组的48.15%比较,差异无统计学意义(P>0.05)。两组患者术后均无明显的胸肌萎缩情况发生。术后3个月、1年,B组患者感觉异常发生率明显高于A组,差异有统计学意义(P<0.05)。两组患者术后肿瘤转移情况比较,差异无统计学意义(P>0.05)。结论行乳腺癌根治手术时可保留保留胸前神经及肋间臂神经,不仅不影响治疗效果,还能减少患者术后感觉异常情况,改善术后生活质量,值得临床推广。

Objective To investigate the clinical significance of preserving anterior thoracic nerve and intercostal brachialnerve in radical mastectomy and its effect on patients. Methods The clinical data of 58 patients with breast cancer treatedin our hospital from January 2012 to May 2015 were retrospectively analyzed. All the patients underwent radicalmastectomy, and 31 patients with preserved anterior thoracic nerve and intercostal brachial nerve were set as group A,while 27 patients with amputated anterior thoracic nerve and intercostal brachial nerve were set as group B. The 3-yeardisease-free survival rate and occurrence of postoperative chest muscle atrophy, abnormal sensation and tumor metastasiswere compared between the two groups. Results The 3-year disease-free survival rate of the group A was 58.06%, whichwas not significantly different from 48.15% of the groupB （P〉0.05）. After surgery, no obvious chest muscle atrophyoccurred in the two groups. At 3 months and 1 year after surgery, the incidences of abnormal sensation in the group B weresignificantly higher than those in the group A（P〈0.05）. There was no significant difference in the rate of tumor metastasisbetween the two groups（P〉0.05）. Conclusion The preservation of anterior thoracic nerve and intercostal brachial nerve inradical mastectomy not only does not affect the therapeutic effect, but also can reduce postoperative abnormal sensation ofpatients and improve postoperative quality of life, which is worthy of clinical promotion.