腔镜乳腺癌改良根治术保留肋间臂神经的临床观察

目的：比较乳腺癌腔镜腋窝淋巴清扫与传统开放腋窝淋巴清扫在保留肋间臂神经（ICBN）方面的效果。 方法：选择拟行乳腺癌改良根治术，术中ICBN的乳腺癌I，II期患者46例，分为腔镜手术组（21例）和传统手术组（25例）。比较两组手术时间，术中出血量及术后并发症，术后对两组患者上臂内侧及腋窝感觉功能进行随访观察。 结果：腔镜组与传统组手术成功保留ICBN分别为20例（20/21）和23例（23/25），两组成功率比较，差异无统计学意义（P=0.658）；与传统组比较，腔镜组腋窝清扫时间较长，而腋窝清扫出血量与术后并发症减少（P<0.001，P=0.029）；全组随访2~20个月，平均16个月，均未见复发，保留ICBN者，均无上臂及腋窝主观异样感觉症状。 结论：腔镜清扫腋窝淋巴结时，保留ICBN是可行的，并在减少出血量和术后并发症方面具有一定的优势。

Endoscopic modified radical mastectomy with intercostobrachial nerve preservation: a comparative clinical study

Objective: To compare the clinical efficacies between endoscopic and traditional open approaches for intercostobrachial nerve preservation during axillary dissection for breast cancer. Methods: Forty-six patients with stage I or II breast cancer, who were scheduled to undergo modified radical mastectomy with intercostobrachial nerve preservation, were randomly designated to either endoscopic group (n=21) or traditional group (n=25). Sensory functions in inner aspect of upper arm and armpit were examined after the operation. Results: In endoscopic group and traditional group, the intercostobrachial nerves were successfully preserved in 20 cases (20/21) and 23 cases (23/25) respectively, and there was no statistical difference in the successful rate between the two groups (P=0.658). The time taken for axillary dissection was prolonged but the volume of blood loss during axillary dissection and postoperative complications in endoscopic group were significantly reduced compared with traditional group (P<0.001, P=0.029). The entire group was followed up for 2 to 20 months with average of 16 months after operation; no recurrence occurred in any of the patients and no abnormal subjective sensations were observed in any of the patients with intercostobrachial nerve preservation. Conclusion: Preservation of intercostobrachial nerve is feasible in endoscopic axillary dissection, which also has the advantages of reducing blood loss and postoperative complications.