保留相关功能神经的改良乳腺癌根治术

Functional nerve preserving modified radical mastectomy

目的探讨改良乳腺癌根治术保留胸前神经及肋间臂神经的方法及临床意义。方法选择Ⅰ、Ⅱ期乳腺癌患者 87例 ,随机分为两组 ,A组 5 2例 ,采用经胸大肌前入路清扫腋窝淋巴结 ,保留胸小肌、胸前神经及肋间神经。B组 (对照组 ) 35例 ,经胸大肌入路清扫腋窝淋巴结 ,切除胸小肌 ,切断肋间臂神经 ,观察随访两组术后情况。结果术后重度胸大肌萎缩 :A组 ,0例 ,B组 2 8例(80 % ) ,2组比较 ,差异有显著性 (χ2 =6 1 34,P <0 0 1)。腋窝及患侧上肢感觉异常 ,A组 3例(5 8% ) ,B组 31例 (88 6 % ) ,2组比较 ,差异有显著性 (χ2 =6 2 2 4 ,P <0 0 1)。结论保留胸前神经及肋间臂神经的改良乳腺癌根治术能够有效地防止胸大肌萎缩和患侧腋窝上肢感觉障碍的发生率。

Objective To investigate the methods and clinical significances of preserving the pectoral nerve(PN) and intercosto-brachial nerve(IBN) in modified radical mastectomy. Methods Eighty-seven patients suffering from breast cancer in stage Ⅰ and Ⅱ were randomly divided into 2 groups. Transpectoral anterior approach was used on patients in group A(n=52),with axillary lymph node dissection, preservation of the pectoralis minor muscles, PNS and IBNS. Patients in group B(n=35) were operated on through transpectoral posterior approach, with dissection of pectoralis minor muscles, sections of PNS and IBNS. Results No case in group A and 28 cases(80%) in group B suffered from postoperative atrophy of pectoralis major muscles(P<0.01). Sensory disturbances were encountered in 3 cases(5.8%) in group A, and 31 cases(88.6%) in group B(P<0.01). Conclusions PN and IBN preserving modified radical mastectomy prevents pectoralis major muscle from being atrophy, decreases the incidence of sensory disturbance of the axilla and arm.