乳腺癌手术保留肋间臂神经探讨

目的：乳腺癌手术仍然是乳腺癌治疗的重要手段,现在最普遍采用改良根治术和保乳手术,均要进行腋窝淋巴结的清扫术,在腋窝清扫术中往往会遇到肋间臂神经的保留与否的问题,不同学者持有不同的观点,为探讨乳腺癌腋窝淋巴结清扫术术中保留肋间臂神经的临床意义和可行性,笔者进行了本研究。方法：选择2000年9月～2007年11月在本院和中国医学科学院肿瘤医院行乳腺癌手术患者296例,其中有46例行保乳加腋窝淋巴结清扫术,随机分为两组,实验组196例,术中保留肋间臂神经共180例,对照组100例,术中常规切除肋间臂神经。术后对两组患者上臂内侧感觉功能、并发症及复发转移进行随访。结果：实验组患者术后上臂感觉麻木疼痛不适10例,发生率为5.5%,而对照组高达97.0%。两组比较差异具有统计学意义（χ2=227.67,P〈0.01）。随访3～10年两组手术的并发症和复发转移率差异无统计学意义（P〉0.05）。结论：乳腺癌腋窝淋巴结清扫术保留肋间臂神经可明显减少患者术后患侧上臂内侧感觉障碍的发生率,提高患者的生活质量,并不增加术后并发症发生率和复发转移发生率,因此值得推广。

The discussion of preserving intercostobrachial nerve in the operation of axillary node clearance for breast cancer

Objective：The operation of breast cancer always adopt modified radical mastectomy and breast conservative operation.Axillary clearance was proceeding in order to evaluate the effect of preserving intercostobrachial nerve in modified radical mastectomy and breast conservative operation.Methods：Chose 296 cases about the breast cancer patients with modified radical mastectomy and breast conservative operation from September 2000 to November 2007 in our hospital and cancer hospital of Chinese Academy of Medical Science,include 46 cases breast conservative operation plus axillary clearance.We randomly divided them into experimental group 196 cases and control group 100 cases.The intereostobrachial nerve was preserved in the experimental group 180 cases and not in the control group.Sensory function,the operation complications and recurrence and metastasis rate were examined after the operation.Results：The patients upper arm numbness,pain and discomfort in 10 cases,the rate was 5.5%,while the control group up to 97.0%.The difference was statistically significant（χ2=227.67,P〈0.01）.3 to 10 years of follow-up of two groups of surgical complications and recurrence rate was no significant difference（P〉0.05）.Conclusion：Preserving intereostobrachial nerve in axillary lymph node dissection for the patients with breast cancer decrease the incidence of sensory disturbance on the skin of medial part of upper arm and can enhance the life quality of the patients after operation.The complications,relapse and metastasis incidence after operation do not increase.Therefore it is worth to popularize