保留胸前神经和肋间臂神经在乳腺癌改良根治术中的临床意义  

Application of preserving the anterior thoracic nerve and intercostobrachial nerve in modified radical mastectomy for breast cancer

作　　者：朱双九[1] 郝占伟[1] 明亮 Zhu Shuangjiu Hao Zhanwei Ming Liang(Department of General Surgery, the Second People＇s Hospital of Lianyungang, Lianyungang 222006, Chin)

机构地区：[1]江苏省连云港市第二人民医院普外科,222006

出　　处：《中国实用医刊》2017年第18期33-35,共3页Chinese Journal of Practical Medicine

摘　　要：目的探讨保留胸前神经和肋间臂神经在乳腺癌改良根治术中的临床意义。 方法63例接受乳腺癌改良根治术患者，术中保留胸前神经和肋间臂神经（保留组）33例，另切除该两组神经（切断组）30例。比较两组手术时间、术中出血量、腋窝淋巴结清扫数目、术后引流量、术后上臂内侧和腋部及胸壁皮肤感觉异常发生率、胸大肌萎缩发生率。 结果两组术中出血量[（122.3±30.1）ml比（125.6±29.4）ml]、清扫腋窝淋巴结数目[（17.4±2.9）枚比（18.2±2.6）枚]和术后引流量[（235.9±50.7）ml比（243.3±58.1）ml]比较差异均未见统计学意义（P均〉0.05）；两组手术时间[（127.3±10.8） min比（120.9±10.3） min]比较差异有统计学意义（P〈0.05）。随访6个月后，保留组感觉异常及胸大肌萎缩发生率显著低于切断组，分别为17.8%（5/33）比53.3%（16/30）和12.1%（4/33）比43.3%（13/30），差异均有统计学意义（P均〈0.01）。两组患者随访期间均无局部或远处转移及死亡病例。 结论在乳腺癌改良根治腋窝淋巴结清扫术中保留胸前神经和肋间臂神经是安全可行的，可有效防止皮肤感觉障碍及胸大肌萎缩。ObjectiveTo investigate the application value of preserving the anterior thoracic nerve（ATN） and intercostobranchial nerve（ICBN） in modified radical mastectomy for breast cancer. MethodsOf the 63 patients underwent modified radical mastectomy for breast cancer. ATN and ICBN in surgery were preserved in 33 cases（preservation group） and resected in the other 30 cases（resection group）. The operative time, operative blood loss, number of dissected lymph nodes, volume of drainage, rates of skin paresthesia and atrophy of the major pectoral muscle were analyzed. ResultsDifferences were not statistically significant in the operation hemorrhage[（122.3±30.1）ml vs （125.6±29.4）ml, P〉0.05], number of dissected lymph nodes[（17.4±2.9）lymph node vs （18.2±2.6）lymph node, P〉0.05], operation drainage volume [（235.9±50.7）ml vs （243.3±58.1）ml, P〉0.05] between the preservation group and the resection group. The operative time in the preservation group was significantly longer than that in the resection group[（127.3±10.8）min vs （120.9±10.3）min, P〈0.05]. There were significant differences in the incidence rate of skin paresthesia [17.8%（5/33） vs 53.3%（16/30）, P〈0.01] and atrophy of the major pectoral muscle [12.1%（4/33） vs 43.3%（13/30）, P〈0.01] between the preservation group and resection group. No local or distant metastasis and death were observed in the two groups during the follow-up period. ConclusionsPreserving the ATN and ICBN in modified radical mastectomy for breast cancer is a feasible and safe technique, it can decrease the incidence of the skin paresthesia and atrophy of the major pectoral muscle significantly.

关 键 词：胸前神经 肋间臂神经 乳癌改良根治术 

分 类 号：R737.9[医药卫生—肿瘤]