乳腺癌改良根治术保留肋间臂神经

目的探讨保留保留肋间臂神经（intercostobrachialnerve，ICBN）在乳腺癌改良根治术中的可行性和临床价值。方法总结分析2007年1月至2010年1月本科施行乳腺癌改良根治术126例I-Ⅲ。期乳腺癌患者。手术常规保留ICBN，若患者出现患侧腋下淋巴结肿大、黏连、固定或ICBN受肿瘤黏连、侵犯则不保留ICBN。126例中，成功保留ICBN93例（保留ICBN组），未能保留者33例（未保留ICBN组）。术后随访1～12个月。比较两组患者术后不同时间患侧胸壁和上臂内侧疼痛麻木等感觉异常的发生情况（卡方检验）和淋巴结切除情况（t检验）。结果术后随访率100％。保留ICBN组平均手术时间为（125±12）min，未保留ICBN组为（115±11）min。保留ICBN组淋巴结切除数目是（19±3）枚，未保留ICBN组是（17±2）枚，两组间差异无统计学意义（P〉0．050）。比较术后1、3、12个月两组患者ICBN支配区感觉异常情况显示，保留ICBN组的ICBN支配区感觉异常情况明显低于未保留ICBN组（P〈0．050）。随访期内两组患者均未发现局部肿瘤复发或远处转移。结论乳腺癌患者行乳腺癌改良根治术保留ICBN明显降低了术后患侧胸壁和上臂内侧疼痛麻木等感觉异常的发生，合理的解剖途径不会延长太多手术时间，也不会增加胸壁和腋窝的复发风险。

Reserving intercostobrachial nerve in modified radical mastectomy for breast cancer

Objective To investigate the clinical value and feasibility of reserving intercostobrachial nerve(ICBN) during modified radical mastectomy for breast cancer.Methods From January 2007 to January 2010,a total of 126 cases with Ⅰ-ⅢA stage breast carcinoma were treated using modified radical mastectomy in our department and their data were analyzed.The intercostobrachial nerve(ICBN) was successfully reserved in 93 patients(the reserving ICBN group),and 33 patients could not reserve ICBN(the nonreserving ICBN group) because of lymphadenectasis,lymph node synechia and immobilization,and ICBN attached or invaded by tumour.The follow-up duration was 1-12 months.Comparison of dysaesthetic in chest wall and upper arm of affected side at different time(Chi-square test) and lymph node resection(t test) between the two groups was done.Results All patients were followed up.The mean time of operation was(125±12) min in the reserving ICBN group and(115±11) min in the non-reserving ICBN group.Lymph nodes resected was 19±3 in the reserving ICBN group and 17±2 in the non-reserving ICBN group,with no statistical difference between the two groups(P>0.050).The incidences of dysaesthetic in chest wall and upper arm of affected side at one,three and 12 months after operation were all much lower in the reserving ICBN group than in the non-reserving ICBN group(P<0.050).During the follow-up no local recurrence or distant metastasis was found in both groups.Conclusion Modified radical mastectomy with reserving intercostobrachial nerve for breast cancer can significantly decrease the incidence of dysaesthesia on the chest wall and upper arm of breast cancer patients after operation.The operation time can not be prolonged much and recurrent risk can not be increased using rational dissection approach.