乳腺癌改良根治术保留肋间臂神经文献分析

目的探讨保留肋间臂神经与切除肋间臂神经在乳腺癌改良根治术中的临床意义,为制定临床合理的个体化手术方案提供证据.方法： 制定原始文献的纳入标准、排除标准及检索策略,搜索关于保留肋间臂神经在乳腺癌改良根治术中的价值和意义方面的临床随机对照试验.检索日期由2000年1月—2012年2月.按cochrane系统评价方法,评价所纳入研究的文献质量,并提取有效数据后采用RevMan5.0软件进行Meta分析.结果纳入12项研究,共计1146例患者.结果： 保留肋间神经可以明显减轻患者上臂内侧感觉功能（随访1个月,3个月,12个月OR1=0.15,95%CI：0.10～0.21;OR3=0.06,95%CI：0.03～0.10; OR12=0.07,95%CI：0.03～0.16））,保留肋间臂神经手术时间较切除肋间臂神经在乳腺癌改良根治所用的时间略延长（MD=6.75,95%CI：3.88～9.26）;随访1～3年乳腺癌局部复发率两种术式术中出血量、清除淋巴结数、术后肩关节运动障碍及皮下积液切除ICBN与保留ICBN均没有明显的差异.结论： 保留肋间臂神经可以明显减轻乳腺癌改良根治术后患侧上臂内侧感觉功能障碍、延长手术时间但对乳腺癌复发率没有明显影响.

Literature Analysis on Modified Radical Mastectomy with Reserved Inter Costobrachial Nerve forBreast Cancer

Objective To explore the clinical significance of difference between reserved inter-costobrachi-al nerve and resected inter-costobrachial nerve in modified radical mastectomy of breast cancer. MethodsThe results of 12 studies including 1146 patients were used to search for the clinical value and significance ofthe radical mastectomy of breast cancer for randomized controlled trails by using Cochrane systematic reviewmethod to evaluate the quality of searched articles, and RevMan5.0 software for Meta-analysis. Results Theretention of inter costobrachial nerve significantly reduced the medial sensory function of upper arm of the pa-tient （follow-up one month, three months, 12 months OR1=0.15,95% CI： 0.10-0.21; OR3=0.06,95% CI：0.03-0.10; OR12=0.07,95% CI： 0.03-0.16））, operation time： time have been extended in retain the inter-costo-brachial nerve than the removal of the intercostal brachial nerve in the modified radical mastectomy of breastcancer （MD=6.75, 95% CI ：3.88-9.26）;there were no significant differences of local recurrence ratio of thosetwo procedures after 1-3 years follow-up; nor in blood loss during operation, number of lymph nodes removed,postoperative disorders of scapular joint’s movement, and in subcutaneous fluid between removal of intercostobra-chial nerve （ICBN） and reserved ICBN. Conclusion To retain the intercostal brachial nerve can significantlyreduce impaired sensory function of upper extremities of the patient who underwent modified radical mastectomyof breast cancer with increased length of surgery time but no significant effect on the recurrence of breast can-cer.