治疗放射性臂丛神经损伤的临床分析

目的探讨在行臂丛神经松解术的同时用健康软组织覆盖创面对治疗放射性臂丛神经损伤（乳腺癌术后进行放射治疗引起）的疗效。方法对1997年9月-2006年2月间治疗的9例放射性臂丛神经损伤患者进行随访及回顾性病例分析。术后随访时间为1个月-8年，平均37．9个月。结果作单纯神经松解术者2例，术后症状无明显改善1例，加重1例。作神经松解及背阔肌皮瓣转移术者5例，术后症状改善3例，无明显改善1例，死亡1例。作神经松解及胸大肌皮瓣转移术者2例，术后症状改善1例，无明显改善1例。同时观察到症状改善者的放射治疗潜伏期长，出现症状至手术时间间隔短。结论对放射性臂丛神经损伤患者行臂丛神经松解术的同时覆盖背阔肌皮瓣（胸大肌皮瓣）可缓解症状，提高患者的生存质量；而且越早诊治其疗效越好。

Clinical analysis of radiation-induced brachial plexopathy

Objective To investigate the effect of myocutaneous flap transfer following neurolysis in the treatment of radiation-induced brachial plexopathy. Methods Retrospective study of 9 cases with radiation-induced brachial plexopathy treated in our deppartment between September 1997 and February 2006 was conducted. The average postoperative follow-up time was 37.9 months, ranging from 1 month to 8 years. Pain relief and functional recovery were assessed. Results Two cases underwent neurolysis only. Symptoms and signs did not improve in one of these cases and deteriorated in the other. Five cases were treated with latissimus dorsi myooutaneeus flap transfer after neurolysis. Three of these had obvious improvement of symptoms and signs. One had no improvement. The other patient died during follow-up. Two cases were treated with neurolysis and pectoralis major myeeutaneous flap transfer. One of these had improvement while the other had no obvious improvement. Those whose symptoms and signs improved postoperatively had a longer latent period after radiation and a shorter interval between symptom onset and treatment. Conclusion Neurolysis combined with myocutaneous flap transfer for wound coverage is effective for symptom relief and improvement of quality of life in patients of radiation induced brachial plexopathy.