乳腺癌改良根治术中保留肋间臂神经的临床价值

The clinical value of retaining intercostal brachial nerve during modified radical mastectomy

目的探讨乳腺癌改良根治术中保留肋间臂神经(ICBN)的临床价值。方法回顾性分析2015年7月至2017年7月湘西自治州人民医院普外科三病区收治的120例乳腺癌患者的临床资料,根据是否保留ICBN分为保留ICBN组(n=70)和未保留ICBN组(n=50)。比较两组术后淋巴结清扫数目、手术时间、胸壁麻木情况、胸壁及上臂内侧疼痛情况、上肢水肿程度。结果两组手术时间、淋巴结清扫数目比较差异无统计学意义。两组胸壁麻木发生率比较差异无统计学意义;保留ICBN组胸壁及上臂内侧疼痛、术后上肢水肿发生率均低于对照组,差异有统计学意义(P<0.05)。结论乳腺癌患者行改良根治术中保留肋间臂神经对改善患者减轻上肢水肿、术后胸壁及上臂内侧疼痛具有积极作用,该术式临床应用已非常成熟,值得临床推广应用。

Objective To explore the clinical value of retaining intercostal brachial nerve(ICBN)during modified radical mastectomy.Methods The clinical data of 120 breast cancer patients admitted to the Third Ward of General Surgery,Xiangxi Autonomous Prefecture People's Hospital from July 2015 to July 2017 were retrospectively analyzed,and they were divided into the retained ICBN group(n=70)and the non-retained ICBN group(n=50)according to whether the ICBN was retained or not.The number of lymph node dissection,operation time,postoperative numbness of the upper limb and chest wall,pain in the chest wall and inner side of the upper arm,and degree of edema of the upper limb were compared between the two groups.Results There was no significant difference in operation time and the number of lymph node dissections between the two groups.There was no significant difference in the incidence of postoperative numbness of the upper limb and chest wall between the two groups;the incidence of chest wall and medial upper arm pain and postoperative upper limb edema in ICBN group were lower than those in the control group,and the difference was statistically significant(P<0.05).Conclusion Preservation of intercostal brachial nerve in modified radical surgery for breast cancer patients has positive effect on intercostal brachial nerve chest wall and medial upper arm pain and alleviating edema of upper limb,preserving intercostal brachial nerve is mature and reliable method.It is worthy of being used as a routine step in modified radical operation.