保留与不保留胸小肌的改良乳腺癌根治术临床效果比较

目的比较保留与不保留胸小肌、胸前神经和肋间臂神经的改良乳腺癌根治术的临床疗效。方法回顾性分析我院1996年1月至2004年12月收治的480例乳腺癌,A组280例,采用经胸大肌前入路清扫腋窝淋巴结,保留胸小肌、胸前神经及肋间臂神经;B组200例,经胸大肌后入路清扫腋窝淋巴结,切除胸小肌、切断胸前神经、肋间臂神经,观察随访两组术后情况。结果术后重度胸大肌萎缩者,A组5例(1.8%),B组80例(40.0%);腋窝及内侧上臂感觉异常者,A组18例(6.4%),B组156例(78.0%),两组比较有统计学差异(P<0.01)。术后3、5年生存率,A组分别为81.2%和52.0%,B组分别为82.1%和61.2%,两组比较无统计学差异(P>0.05)。结论保留胸小肌、胸前神经和肋间臂神经的改良乳腺癌根治术,可在保证根治效果的同时提高患者的生活质量。

Comparison of Clinical Effect of Modified Radical Mastectomy with or without Preservation of Minor Pectoral Muscle

Objective To Compare the clinical effect of modified radical mastectomy with or without preservation of minor pectoralis muscle, anterior thoracic nerve, and intercostobrachial nerve. Methods The clinical data of 480 patients admitted from January 1996 to December 2004 were retrospectively analyzed. Axillary lymph node clearance was performed via transectopectoralis anterior approach in group A(n=280) and posterior approach in group B(n=200). The pectoralis minor muscles, pectoral nerve(PN) and intercostobrachial nerve(IBN) were preserved in group A and resected in group B, postoperative result was compared between two groups. Result 5 cases (1.8%) in group A and 80 cases (40.0%) in group B suffered from postoperative atrophy of pectorals major muscles, 18 cases (5.7%) in group A and 156 cases (78.0%) in group B suffered from sensory disturbances in axillary and upper arm interior area, showing a significant difference between two groups (P<0.01). The 3, 5-year survival rates were 81.2% and 52.0% in group A respectively, versus 82.1% and 61.2% in group B. There was no significant difference between two groups (P>0.05). Conclusion Minor pectoral muscles, PN and IBN preserved modified radical mastectomy can improve patients'quality of life while ensuring the oncological resection.