保留肋间臂神经在乳腺癌改良根治术中的方法和临床意义

目的:探讨乳腺癌改良根治术中保留肋间臂神经(ICBN)的方法和临床意义。方法:将我科自2003年1月-2009年5月收治的52例Ⅰ~Ⅲ期乳腺癌患者分为保留ICBN组和不保留ICBN组,并对两组患者术后进行随访观察。结果:两组乳腺癌切除均行常规改良根治术,保留肋间臂神经或保留上干或上支组34例,患侧上臂内侧及腋部皮肤感觉正常30例(88.2%),感觉异常4例(11.8%);不保留ICBN组18例患者感觉异常12例(66.7%),无异常感觉6例(33.3%)。两组比较具有显著性差异(P<0.01)。两组肿瘤随访均无局部复发。结论:腋静脉下方途径最为方便和安全,Ⅰ、Ⅱ、Ⅲa期乳腺癌腋窝淋巴结切除术时保留肋间臂神经可以明显减少术后患侧上肢感觉障碍及疼痛,提高生活质量。

Significance and Methods of Preserving Intercostobrachial Nerve during Modified Radical Mastectomy for Breast Cancer

Objective：To investigate the clinical value of preserving intercostobrachial nerve（ICBN） during modified radical mastectomy.Methods：From January 2003 to May 2009,52 cases withⅠⅢa stage mammary carcinoma were divided into two groups,experimented group（preserving ICBN）and control group（resecting ICBN）.The two groups were followed up after operation.Results：The modified radical mastectomy was performed for mammary carcinoma in two groups.The postoperative arm sensory disturbance was 88.2%（30/34）in the experimented group,which was significantly different from that of the control group 66.7%（12/18,P〈0.01）.The incidence of pain is 11.8%（4/34）in the experimented group,which was also significantly different from that of control group 33.3%（12/18,P〈0.01）.No local tumor recurrence was found in two groups.Conclusion：Preserving intercostobrachial nerves may significantly decrease the postoperative morbidity of arm sensory disturbance and pain during axillary excision of stage Ⅰ,Ⅱ,Ⅲa breast cancer patients.