乳腺癌Auchincloss术中保护肋间臂神经、胸肌神经的意义

目的:探讨在乳腺癌Auchincloss术中保护肋间臂神经、胸肌神经的临床意义.方法:对2008年9月-2010年10月间的38例乳腺癌患者,在Auchincloss术中行腋淋巴结清扫时,注意游离并保护肋间臂神经、胸肌神经,随访观察术前、术后患者胸大肌功能、胸大肌外缘厚度、上臂内侧及腋部皮肤感觉功能的变化;腋窝淋巴结清扫的数量,对术中保护肋间臂神经、胸肌神经的价值进行评估.结果:38例患者中患侧上臂内侧及腋部皮肤感觉正常32例,感觉异常仅2例,占5.6%,4例腋窝淋巴结明显肿大与之黏连,放弃保留肋间臂神经;38例患者均成功保留胸肌神经,经术后随访观察,胸大肌功能均为5级,术后6个月复查B超,胸大肌外缘厚度与术前比较无明显差异.结论:在乳腺癌Auchincloss术中注意保护肋间臂神经、胸肌神经可有效避免术后上臂内侧皮肤感觉障碍及胸大肌萎缩,能明显改善患者术后生存质量,对手术疗效并无影响.

The importance of protecting intercostobrachial nerve and pectoralis nerve in Auchincloss operation of breast cancer

Objective:To study the clinical significance of preserving intercostobrachial nerve(ICBN) and pectoralis nerve during Auchincloss operation of breast cancer.Methods:For 38 patients with breast cancer,pay attention to free and protect the ICBN and pectoralis nerve in Auchincloss and follow-up all patients.Results: Among the 34 cases with ICBN reserved,32 cases had normal sensory function of the medial upper arm,2 cases(5.6%) were abnormal;All 38 cases,In comparison with the preoperative,the lateral border thickness changes of ill side pectoralis major and the function of pectoralis major had no significance differences;In comparison with the postoperative,the cleaning number of axillary lymph nodes had no significant difference.Conclusion: In breast cancer Auchincloss to protect the ICBN and pectoralis nerve can effectively prevent postoperative arm cutaneous sensory disorders and pectoralis major muscle atrophy,and improve the quality of life for postoperative patients.