超声刀在乳腺癌改良根治术中保留胸肌神经及肋间臂神经的应用价值  

Application Value of Ultrasound Knife in Modified Radical Mastectomy of Breast Cancer for Remaining Pectoral Nerve and Intercostobrachial Nerve

作　　者：杜果城 张茂春[2] 刘臻臻 朱克鹏 弋文 朱冬梅 

机构地区：[1]四川省南充市中心医院普外三科,四川南充637000 [2]川北医学院附属医院妇产超声科,四川南充637000 [3]四川省南充市中心医院超声科,四川南充637000

出　　处：《中国普外基础与临床杂志》2015年第2期220-223,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨在乳腺癌改良根治术中应用超声刀保留胸肌神经及肋间臂神经的可行性及临床价值。方法回顾性分析2011年1月至2014年1月期间南充市中心医院应用配备FOCUS刀头的HARMONIC超声刀行乳腺癌腋窝淋巴结清扫手术80例乳腺癌患者(超声刀组)的临床资料,并选择同期、同一术者以高频单极电刀完成的腋窝淋巴结清扫手术80例乳腺癌患者作为对照(电刀组),比较2组的手术时间及术后3个月、6个月时的胸大肌厚度和术后2周、3个月、6个月时的腋部及上臂内侧皮肤感觉情况。结果 1 2组患者年龄、体质量指数及手术时间比较差异无统计学意义(P>0.05)。2术后6个月时,超声刀组双侧胸大肌厚度比较差异无统计学意义〔(8.3±2.5)mm比(8.7±2.9)mm,P=0.352〕,电刀组患侧胸大肌厚度明显小于健侧〔(5.2±3.6)mm比(8.9±3.2)mm,P=0.001〕。3超声刀组术后2周、3个月、6个月时腋部及上臂内侧皮肤感觉异常率较电刀组低(2周:23.8%比37.5%,P=0.059;3个月:10.0%比30.0%,P=0.002;6个月:6.3%比25.0%,P=0.001)。结论应用超声刀行乳腺癌改良根治术腋窝淋巴结清扫可以更好地保护胸肌神经及肋间臂神经,减少术后神经功能异常的发生。Objective To investigate the value of ultrasound knife in modified radical mastectomy for remaining pectoral nerve and intercostobrachial nerve. Methods One hundred and sixty patients with breast cancer were divided into ultrasound knife group and electroscalpe group and then performed modified radical mastectomy with pectoral nerve and intercostobrachial nerve remainning. the pectoralis major thickness and paresthesia of skin of inner upper arm and axillary fossa were detected on the different time after operation. Results ① The age, body mass index, and mean operation time had no significant differences between these two groups（P〉0.05）. ② On 6 months after operation, the thickness of bilateral pectoralis major was not significantly different in the ultrasound knife group（P〉0.05）, which of injuried pectoralis major was significantly thinner than that of uninjuried pectoralis major in the electroscalpe group（P〈0.05）.③ The rates of paresthesia of skin on postoperative 3 months and 6 months in the ultrasound knife group were significantly lower than those in the electroscalpe group（P〈0.05）. Conclusion Compared with monopolar electro diathermy, the use of ultrasonic harmonic scalpel in modified radical mastectomy could better protect pectoral nerve and intercostobrachial nerve, and thus decrease nerve parafunctional rate.

关 键 词：超声刀 乳腺癌 改良根治术 胸肌神经 肋间臂神经 

分 类 号：R737.9[医药卫生—肿瘤]