乳腺癌改良根治术保留肋间臂神经的临床效果及预后分析

Clinical effect and prognosis analysis of modified radical mastectomy with intercostobrachial nerve preservation for breast cancer

目的探讨乳腺癌改良根治术保留肋间臂神经的临床效果及预后。方法选取2017年1月—2018年7月就诊于本院的90例乳腺癌患者,按随机数字表法分为2组,各45例。2组均行乳腺癌改良根治术治疗,实验组术中保留肋间臂神经,对照组术中不保留肋间臂神经。对比2组围术期指标、术后远处转移、复发、感觉功能障碍、肋间与前壁感觉异常面积情况。结果实验组住院时间为(7.45±1.29)d,短于对照组的(8.45±1.42)d,差异有统计学意义(t=3.497,P<0.001);2组术中失血量、手术用时、淋巴结清扫数量、复发率、远处转移率相比,差异无统计学意义(P>0.05);实验组术后1个月、3个月感觉功能障碍评分、肋间和前壁感觉异常面积分别为(2.05±0.69)分、(2.88±0.83)分、(4.12±0.69)cm2、(2.42±0.19)cm2,对照组分别为(1.62±0.55)分、(2.09±0.71)分、(14.28±2.82)cm2、(7.95±1.88)cm2,差异有统计学意义(P<0.05)。结论乳腺癌改良根治术中将肋间臂神经保留能促进患者恢复,缩短住院时间,可使术后肋间与前壁感觉异常面积减小,减轻感觉功能障碍程度,对预后无明显影响。

Objective To investigate the clinical effect and prognosis of modified radical mastectomy with intercostobrachial nerve preservation for breast cancer.Methods Ninety patients with breast cancer who were admitted to a hospital from January 2017 to July 2018 were enrolled in the study.They were divided into two groups(an experimental group and a control group)according to the random number table,45 cases in each group.Both groups underwent modified radical mastectomy.The experimental group retained the intercostobrachial nerve during the operation,and the intercostobrachial nerve was not preserved in the control group.The perioperative indicators,postoperative distant metastasis,recurrence,sensory dysfunction,and intercostal and anterior wall paresthesia were investigated and compared between the two groups.Results The time of hospital stay in the experimental group was(7.45±1.29)d,which was shorter than that of the control group[(8.45±1.42)d],and the difference was statistically significant(t=3.497,P<0.001).There were no significant differences between the two groups in the blood loss,the time of surgery,the number of lymph node dissection,the recurrence rate and the distant metastasis rate(P>0.05).In the experimental group,the scores of sensory dysfunctions were(2.05±0.69)and(2.88±0.83)in 1 month and 3 months after the operation respectively;the areas of intercostal and anterior wall paresthesia were(4.12±0.69)cm2 and(2.42±0.19)cm2 in 1 month and 3 months after the operation respectively.In the control group,the scores of sensory dysfunction were(1.62±0.55)and(2.09±0.71)in 1 month and 3 months after the operation respectively;the areas of intercostal and anterior wall paresthesia were(14.28±2.82)cm2 and(7.95±1.88)cm2 in 1 month and 3 months after the operation respectively,and the differences were statistically significant(P<0.05).Conclusion mastectomy for breast cancer,the retention of intercostobrachial nerve can promote the recovery of patients and shorten the length of hospital stay.It can reduce the abnormal areas of intercostal space and anterior wall,reduce the degree of sensory dysfunction,and it has no significant effect on prognosis.