乳腺癌手术中保留肋间臂神经的临床意义

目的 探讨乳腺癌手术中腋窝淋巴结切除时保留肋间臂神经的临床意义及手术注意事项。方法 2003年1月至2006年1月对70例Ⅰ、Ⅱ期乳腺癌施行腋淋巴结清扫术，其中完整保留肋间臂神经40例，切除肋间臂神经30例。术后对病人进行观察随访。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％），感觉异常为4例（10.0％），而切除间臂神经的30例病人中28例有感觉异常，两者之间差异显著（P〈0.05）。术后4—36个月随访未发生肿瘤局部复发。结论 Ⅰ、Ⅱ期乳腺癌腋淋巴结清扫术中保留肋间臂神经可以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 patients with breast cancer

Objective To study the clinical significance and operative technique for preservation of intereostobrachial 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 70 patients with stage Ⅰ and Ⅱ breast cancer during January 2003 to January 2005. ICBN was completely preserved in 40 patients, and it had been dissected in 30 patients. Follow - up was carried out in all patients and the sensation of arms and axillas was recorded after operation. Results Among 40 patients with ICBN being preserved , 36 patients （ 90% ） had normal skin sensation of upper medial ann and axilla , 4 patients （10%） had paresthesia; while twenty- eight of 30 patients with dissected ICBN suffered from paresthesia; there was significant difference between these two groups （ P 〈 0.05 ）. No local recurrence was found during the follow - up period ranging from 4 months to 36 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 and Ⅱ breast cancer, and it improves the quality of life （QOL） for patients after operation.