乳腺癌术后放射性臂丛神经病变的临床分析

Clinical analysis of radiation induced brachial plexopathy after breast cancer surgery

目的探讨乳腺癌术后放射性臂丛神经病变的临床特点及神经松解术的疗效。方法回顾性分析2011至2015年收治的5例乳腺癌术后放射性臂丛神经病变患者的无症状间歇期、淋巴水肿、疼痛、臂丛神经病变范围、程度及电生理特点,评价神经松解术的疗效。结果随访8~36个月,平均随访15个月;患者的无症状间歇期4.5~8年,平均5.8年;就诊前病程4~8个月,平均6.3个月;淋巴水肿不明显,2例有可耐受的疼痛不适,4例累及正中、尺、桡神经,1例累及全臂丛,但以正中、尺、桡神经为重。均无Horner征。电生理检查支持臂丛神经损伤的诊断,受累神经未测出SNAP4例,运动神经的波幅和传导速度明显减低2例,纤维束颤1例。术中发现瘢痕广泛,神经外膜增厚,无法彻底完全松解。伴有局部慢性溃疡1例,皮瓣修复后伤口延迟愈合。术后感觉障碍仅在短期内有所缓解2例;运动障碍无明显改善3例,有加重2例。病理均未发现肿瘤组织。结论乳腺癌术后放射性臂丛神经病变是一种缓慢进展的疾病,手术松解效果不佳。

Objective To investigate the clinical characteristics of radiation induced brachial plexopathy(RIBP)after breast cancer surgery and the curative effects of neurolysis. Methods Five patients with RIBP after breast cancer surgery who were admitted and treated in our hospital from 2011 to 2015 were enrolled in the study,whose clinical data including asymptomatic intermission, lymphedema, pain extent, the scope and degrees of brachial plexus neuropathy, and electrophysiological characteristics were retrospectively analyzed,moreover,the curative effects of neurolysis were evaluated.Results The duration of follow-up visit was 8 ~ 36 months,with average follow-up time being 15 months. The asymptomatic intermission duration of patients was 4. 5 years ~ 8 years,and the average time was 5. 8 years. The course of disease before hospital visit was 4 ~ 8 months,and the average time was 6. 3 months. Lymphedema of patients were not obvious,and there were 2 cases of the tolerable pain and discomfort,and 4 cases involved in median nerve,ulnar nerve and radial nerve,1 case involved in entire brachial plexus nerve but with the most serious of median nerve,ulnar nerve and radial nerve. Horner sign was negative in all the patients. Electrophysiological examination results identified the presence of brachial plexus nerve injury. There were 4 cases whose affected nerves were not detected SNAP,and 2 cases with obvious decline of amplitude and conduction velocity in motor nerve,and 1 case with myokymia. During the operation,there were extensive scar,epineurium thicking,and it was difficult to release completely. There was 1 case accompanied with regional chronic ulcer which wound delayed union after flap repairing. Moveover there were 2 cases whose postoperation sensory disturbance relieved in a short time. However there were 3 cases whose dyscinesia had no obvious improvement,and 2 cases with exacerbation. No tumor cells were found in histological pathology examination. Conclusion Radiation induced brachial plexopathy is a kind of slowly progressive disease,and the curative effects of neurolysis are not satisfactory.