乳腺癌改良根治术中保留肋间臂神经的技巧和意义

目的：探讨乳腺癌改良根治手术中腋窝淋巴结清扫时保留肋间臂神经的手术技巧及临床意义。方法：对2007年7月至2009年7月期间Ⅰ、Ⅱ、Ⅲa期48例乳腺癌患者施行乳腺癌改良根治腋淋巴结清扫术,其中完整保留肋间臂神经40例,切除肋间臂神经8例,术后对病人进行3-24个月随访观察。结果：保留肋间臂神经40例中术后患侧上臂内侧及腋部皮肤感觉正常36例（90.0%）,感觉异常4例（10.0%）,而切除肋间臂神经的8例病人中7例有感觉异常,两者之间差异显著。术后3-24个月随访未发生肿瘤局部复发。结论：Ⅰ、Ⅱ、Ⅲa期乳腺癌腋淋巴结清扫术中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,改善生活质量。

The clinical significance of preservation of intercostobrachial nerve during radical resection in paients with breast cancer

Objective：To study the clinical significance and operative technique for preservation of intercostobrachial nerve（ICBN）during dissection of axillary lymph nodes for surgical treatment of breast cancer.Methods：Preservation of ICBN during dissection of axillary lymph nodes was performed in 48 patients with stage I,II and IIIa breast cancer during July 2007 to July 2009.ICBN was completely preserved in 40 patients,and it had been dissected in 8 patients.Follow up was carried out in all patients and the sensation of arm and axillas was recorded after operation.Results：Among 40 patients with ICBN preserved,36 patients（90%）had normal skin sensation of upper medial arm and axilla,4 patients（10%）had paresthesia;while 7 of 8 patients with dissected ICBN sufered from paresthesia;there was significant diference between two groups.No local recurrence was found during the follow up period ranging from 3 months to 24 months.Conclusion：Preservation of intercostobrachial nerves may significantly decrease the postoperative morbidity of sensory disturbance and pain of arms during axillary lymph node dissection in patients with stage I ,Il and IIIa breast cancer,and it improves the quality of life for patients after operation.