乳腺癌腋淋巴结清扫术中保留肋间臂神经的组织学观察  

Histological observation of preserving intercostobrachial nerve during axiHary lymph node dissection for breast carcinoma

作　　者：郑桓[1] 石畅[3] 张世伟[3] 唐照鹏 陈源水[5] 丁梅[6] 朱红成[3] 向聚才[4] 孙红[2] 宋旭东[4] 徐卫国[3] 

机构地区：[1]河北联合大学基础医学院解剖学教研室,河北唐山063000 [2]河北联合大学基础医学院病理教研室,河北唐山063000 [3]河北联合大学附属医院肿瘤外科 [4]河北联合大学附属医院病理科 [5]福建省安溪县医院肿瘤放疗科 [6]河北省唐山市协和医院普外科

出　　处：《中华医学杂志》2014年第46期3646-3648,共3页National Medical Journal of China

基　　金：河北省科技支撑资助项目（09276101D.11）;河北省卫生厅科研基金资助项目（0818J）

摘　　要：目的探讨保留肋间臂神经（ICBN）的乳腺癌腋淋巴结清扫术的安全性。方法留取2013年1-10月间河北联合大学附属医院肿瘤外科乳腺癌常规手术中切除的57例ICBN及其周围组织，进行HE染色，镜下观察其病理变化，对镜下见有癌细胞浸润者，免疫组化法检测癌细胞中人乳腺珠蛋白（hMAM）等4种标志物的表达。结果57例切除的ICBN及周围组织，55例未见癌细胞浸润，27例伴患侧腋窝淋巴结肿大的患者中1例可见ICBN受癌细胞浸润，1例于神经周围组织中可见癌细胞；浸润ICBN的癌细胞雌激素受体（ER）、孕激素受体（PR）、hMAM、大囊泡病液体蛋白．15（GCDFP-15）均阳性表达，浸润周围组织的癌细胞ER、PR、hMAM阳性表达，GCDFP．15阴性表达。结论除~ICBN与肿大的淋巴结粘连严重而将其切除外，保留ICBN的乳腺癌手术是安全可行的。Objective To explore the reliability of preserving intercostobrachial nerve （ICBN） during axillary lymph node dissection for breast carcinoma. Methods A total of 57 patients with breast carcinoma undergoing routine operations were analyzed. The extirpated ICBN and ambient tissues were tested by hematoxylin and eosin staining to observe the pathological changes under microscope. If there was an infiltration of carcinoma, 4 immunohistochemical markers, including human mammaglobin （hMAM） , were tested in related tissue. Results Among them, no microscopic infiltration of carcinoma was found in 55 cases. In 27 cases with axillary lymph node metastasis, 1 case had an infiltration of carcinoma and carcinoma cells were present in tissues around ICBN in another case. Immunohistochemistry showed that hMAM, GCDFP-15, estrogen receptor （ER） and progesterone receptor （PR） were all positive in infiltrated ICBN. And carcinoma cells in tissues around ICBN expressed ER, PR and hMAM positively and GCDFP-15 negatively. Conclusion Unless intercostobrachial nerves and enlarged lymph nodes adhere heavily, preserving ICBN is feasible for breast carcinoma surgery.

关 键 词：乳腺肿瘤 病理学 免疫组化 肋间臂神经 

分 类 号：R737.9[医药卫生—肿瘤]