乳腺癌改良根治术中发生肋间臂神经损伤的影响因素分析

Influencing factors of intercostobrachial nerve injury during modified radical mastectomy

目的观察乳腺癌改良根治术中肋间臂神经损伤的发生情况,并分析患者术中发生肋间臂神经损伤的影响因素。方法回顾性分析150例行改良根治术的乳腺癌患者病历资料,统计患者术中肋间臂神经损伤发生情况并据此将患者分为发生组和未发生组。比较2组患者临床资料,多因素回归分析导致肋间臂神经损伤发生的影响因素。结果150例接受乳腺癌改良根治术的患者中有15例(10.00%)术中发生肋间臂神经损伤。2组患者BMI、实施腋窝溶脂操作、术中保留胸小肌、腋淋巴结清扫解剖途径比较,差异有统计学意义(P<0.05);Logistic回归分析结果显示,BMI≥24 kg/m^(2)、未实施腋窝溶脂操作、术中未保留胸小肌和经背阔肌途径清扫淋巴结是乳腺癌改良根治术中发生肋间臂神经损伤的危险因素(OR>1,P<0.05)。结论BMI≥24 kg/m^(2)、未实施腋窝溶脂操作、术中未保留胸小肌和经背阔肌途径清扫淋巴结可能会增加乳腺癌改良根治术中肋间臂神经损伤发生的风险,临床应引起重视并尽早干预,以降低肋间臂神经损伤的发生率。

Objective To observe the occurrence of intercostobrachial nerve injury during modified radical mastectomy,and analyze the influencing factors of intercostobrachial nerve injury in patients.Methods The clinical records of 150 patients with breast cancer who received modified radical mastectomy were retrospectively analyzed,the occurrence of intercostobrachial nerve injury during operation in patients was collected and they were divided into the occurrence group and the non-occurrence group.The clinical data of patients in the two groups were compared,the influencing factors leading to intercostobrachial nerve injury during operation were analyzed by multivariable regression analysis.Results Among the 150 patients who received modified radical mastectomy,15 cases(10.00%)had intercostobrachial nerve injury during operation.There were statistically significant differences in BMI,performance of axillary lipolysis during operation,preservation of pectoralis minor muscle during operation and anatomical approach of axillary lymph node dissection of patients between the two groups(P<0.05);the results of Logistic regression analysis showed that BMI≥24 kg/m^(2),without the performance of axillary lipolysis,without the preservation of pectoralis minor muscle during operation and lymph node dissection via latissimus dorsi approach were the risk factors of intercostobrachial nerve injury during modified radical mastectomy(OR>1,P<0.05).Conclusion BMI≥24 kg/m^(2),without the performance of axillary lipolysis,without the preservation of pectoralis minor muscle during operation and lymph node dissection via latissimus dorsi approach may increase the risk of intercostobrachial nerve injury during modified radical mastectomy,clinical attention and early intervention should be paid to reduce the incidence of intercostobrachial nerve injury.