乳腺癌改良根治术中保留肋间臂神经的手术方法及临床意义

目的探讨乳腺癌改良根治术中保留肋间臂神经(intercostobrachial nerve,ICBN)的手术方法及临床意义。方法回顾性分析120例Ⅰ、Ⅱ期乳腺癌患者,分为两组:实验组64例,行乳腺癌改良根治术时保留ICBN;对照组56例,行常规乳腺癌改良根治术,术中切除ICBN。结果实验组手术时间平均为(81.3±29.2)min;对照组为(72.5±25.6)min,两组比较无显著性差异(P0.05)。术后6个月时对患侧腋窝及上臂内侧感觉功能进行观察,实验组中正常56例(87.5%),异常8例(12.5%);对照组中正常18例(32.1%),异常38例(67.9%),两组比较,差异有统计学意义(P0.01)。平均随访15(6~24)月,均未见肿瘤局部复发或转移。结论Ⅰ、Ⅱ期乳腺癌行改良根治术时保留ICBN可明显减少术后患侧腋窝、上臂内侧感觉障碍和疼痛,从而提高生活质量,且不会明显延长手术时间或增加复发风险。

The Clinical Significance and Surgical Methods of Intercostobrachial Nerve Reservation in the Modified Radical Mastectomy

Objective To study the surgical methods of intercostobrachial nerve（ICBN） reservation in the modified radical mastectomy and the clinical significance of the ICBN-saving mode in occurrence of postoperative pain and sensory dysfunction in axilla and upper medial arm of the affected side.Methods A retrospective analysis was conducted in 120 patients with stage Ⅰ/Ⅱ breast cancer underwent modified radical mastectomy.The ICBN was kept in experimental group（64 cases）,but removed in the control group（56 cases） during the operation.Results The operation time of the experimental group was（81.3±29.2）min in average while（72.5±25.6）min of the control group.No significant difference（P〉0.05） was found between these two groups.In the postoperative pain and sensory function study,there were 8（12.5%） abnormal cases,56（87.5%） normal cases in the experimental group and 38（67.9 %） abnormal,18（32.1%） normal cases in the control group,which showed a statistically significant difference（P〈0.01）.No recurrence was found after a 6-24 months＇ follow-up.Conclusion Retaining ICBN in the modified radical mastectomy for stage Ⅰ/Ⅱ breast cancer can significant reduce postoperative pain and sensory dysfunction in the axilla and upper medial arm of the effected side,and thus improve the quality of life,without prolonging the operation time or increasing the recurrence risk.