乳腺癌根治术中保留肋间臂神经的临床研究

目的探讨乳癌手术腋窝淋巴结清扫时保留肋间臂神经(ICBN)的临床价值。方法对146例Ⅰ、Ⅱ、Ⅲa期乳癌患者行改良根治术的临床资料进行分析。将其随机分为两组:保留组(67例)行腋窝淋巴结清扫术时保留ICBN,对照组(79例)行腋窝淋巴结清扫时常规切除ICBN,比较两组在手术时间、淋巴结清扫数量及术后上臂内侧感觉异常等情况。结果保留组及对照组术后1、3、6个月患侧上臂内侧感觉障碍发生率分别为17.9%、74.9%(P<0.01);11.9%、60.7%(P<0.01);7.4%、59.5%(P<0.01),差异有统计学意义,手术时间及淋巴结清扫数比较差异无统计学意义,术后8个月至5年随访无局部复发。结论对Ⅰ、Ⅱ、Ⅲa期乳癌患者在行腋窝淋巴结清扫时保留ICBN可明显减少术后患侧上臂内侧感觉障碍,提高生活质量,不增加局部复发率。

Clinical research of preserving intercostobrachial herre during axillary lymph node dissection

Objective To study the clinical value of preserving intercostobrachial nerve(ICBN)during axillary lymph node dissection.Methods The clinical data of 146 cases of operated cancer of stage Ⅰ,Ⅱ,Ⅲa were analyzed.All cases were divided into two groups randomly;preserved group(n=67)preserved ICBN in axillary lymph node dissection operation;control group(n=79)resected ICBN regulary in the operations.The number of lymph node dissection and the incidence of abnormal sense on the skin of inside upper arm were compared between groups.Results In one month,three months and six months followed up:the incidence of abnormal sense on the skin of inside upper arm was 17.9%,11.9%,7.4%in preserved group,which was lower than that(74.9%,60.7%,59.5%)in control group significantly(P<0.01).The difference between the two groups was significant.No local recurrence was occurred after operations from eight months to five years examined.It was not different that period of operation and the number of lymph node dissection between the groups.Conclusion Preserving ICBN in axillary lymph node dissection for breast cancer of stage Ⅰ,Ⅱ,Ⅲa could decrease the incidence of abnomal sence on the skin of inside upper arm.It couldn′t increase the incidence of local recurrence.It can improve the life quality of the patients after operations.