肋间臂神经的解剖及其临床意义

The anatomy and clinical significance of intercostobrachial nerves

目的 :为乳癌腋清扫术中保留肋间臂神经 (ICBN)提供解剖学基础。方法 :对 2 5具成人尸体的5 0侧腋区进行了解剖 ,对肋间臂神经及上下相邻皮神经的走行、分支、支配、粗细等情况进行解剖观察。结果 :ICBN可分为缺如型、单干型、单干分支型、双干型及 3干型 ;84%的臂内侧皮神经与ICBN上支、上干相交通 ;3 4%的第 3肋间神经外侧皮支可发支支配腋窝底 ;3侧第 1肋间神经外侧皮支主干进入上臂内侧。结论 :肋间臂神经为第 2肋间神经外侧皮支的分支 ,通常为上支或上干 ,与臂内侧皮神经联合构成 ,可有第 3或第 1肋间神经的外侧皮支参与。其损伤可造成乳房切除术后疼痛综合征 ,乳癌腋清扫术中经胸小肌后方或经腋静脉下方能顺利找到该神经并加以保护。

Objective: To provide anatomic basis for the preserving of the intercostobrachial nerves(ICBN)during axillary node clearance for breast cancer. Methods: The ramus, courses and domination of the intercostobrachial nerve, medial brachial cutaneous nerve and lateral cutaneous branches of the first, third intercostal nerves were observed on 25 adult embalmed cadavers(50 sides). Results: ICBN can be divided into five types, including vacancy type, single trunk type, single trunk with branches, two trunks and three trunks type. 84% of medial brachial cutaneous nerve linked with the upper trunk or branch of ICBN, and cooperated with ICBN in dominating the inner part of the upper arm. 34% of lateral cutaneous branch of the third intercostal nerve distributed branches to axillary.3 lateral cutaneous branch of the first intercostal nerve's main trunk dominated the inner part of upper arm. Conclusions: ICBN is mainly composed by superior trunk or superior branch of the lateral cutaneous nerve of the second intercotal nerve and the medial brachial cutaneous nerve, while the cutaneous nerve of the first and the third intercostal nerve can distribute branches to it. The injuries of ICBN could result in the occurrence of the post-mastectomy pain syndrome(PMPS). It is recommended to preserve these nerves during axillary node clearance for breast cancer to prevent the occurrence of PMPS.