乳腺癌腔镜腋窝淋巴结清扫术中保留肋间臂神经的临床价值

目的探讨乳腺癌腔镜腋窝淋巴结清扫(endoscopic axillary lymph node dissection,EALND)术中保留肋间臂神经的可行性和临床价值。方法回顾分析2006年10月～2008年12月接受腔镜腋窝淋巴结清扫手术并随访资料完整的89例Ⅰ、Ⅱ期乳腺癌患者的临床资料,其中保留肋间臂神经68例,未保留21例。对比2组术后患侧上臂内侧及腋窝皮肤感觉情况、手术时间。结果肋间臂神经保留组术后上臂内侧及腋窝皮肤感觉异常9例(13.2%),未保留组15例(71.4%),二者差异有显著性(χ2=27.859,P=0.000)。保留组EALND时间(93.1±31.2)min,未保留组(87.5±25.6)min,二者差异无显著性(t=0.751,P=0.455)。89例术后随访27～45个月,平均36个月,均未发现肿瘤复发及切口种植转移。结论Ⅰ、Ⅱ期乳腺癌EALND术中保留肋间臂神经临床可行,能够明显减少术后患侧上肢感觉障碍及疼痛的发生,改善生活质量。

Preservation of the Intercostobrachial Nerve during Endoscopic Axillary Lymph Node Dissection for Patients with Breast Cancer

Objective To evaluate the feasibility and significance of preserving intercostobrachial nerve(ICBN) during endoscopic axillary lymph node dissection(EALND) for patients with breast cancer.Methods Preservation of ICBN during endoscopic axillary lymph node dissection was performed on 89 patients with stage Ⅰor Ⅱ breast cancer from October 2006 to December 2008.ICBN was preserved completely in 68 cases,and completely or partly dissected in the other 21 cases.The skin sensation at the medial upper arm and axilla,and operation time of the preservation and non-preservation groups were compared.Results Nine patients from the preservation group and 15 patients from the non-preservation group had abnormal sensation at the medial upper arm and axilla skin(13.2% vs.71.4%,χ2=27.859,P=0.000).The operation time for EALND was(93.1±31.2)min in the preservation group,which was not significantly different from that in the non-preservation group (87.5±25.6) min,t=0.751,P=0.455].The 89 patients were followed up for 27 to 45 months with a mean of 36 months,during which no recurrent tumor or incisional metastasis occurred.Conclusions ELAND with the ICBN preserved is feasible for patients with Ⅰor Ⅱ breast cancer.It can decrease the rate of abnormal skin sensation after the procedure and improve life quality of the patients.