老年乳腺癌病人改良根治术中保留肋间臂神经的临床评价  

Clinical evaluation of the preservation of intercostobrachial nerves(ICBN) in modified radical mastectomy for elderly patients with breast cancer

作　　者：王国柱[1] 张斌[1] 张跃华 唐崇寅 徐锦[1] 陈晶[1] 姜鹏[1] WANG Guo-zhu;ZHANG Bin;ZHANG Yue-hua;TANG Chong-yin;XU Jin;CHEN Jing;JIANG Peng(Department of Thyroid and Breast Surgery,Nanjing Hospital Affiliated to Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院甲状腺乳腺外科

出　　处：《实用老年医学》2019年第12期1180-1182,共3页Practical Geriatrics

摘　　要：目的探讨老年乳腺癌改良根治术中保留肋间臂神经(intercostobrachial nerves,ICBN)的安全性及对术后并发症的影响。方法选取南京医科大学附属南京医院(南京市第一医院)乳腺外科2014年2月至2017年2月间行乳腺癌改良根治术的老年乳腺癌病人(年龄均≥60岁)49例,其中试验组24例,均行保留ICBN的乳腺癌改良根治术,同期25例行乳腺癌改良根治术的老年病人入对照组,该组病人均切除ICBN。观察对照组ICBN及周围组织HE染色情况,并比较2组术后并发症发生率、感觉功能障碍量化评分情况、术后感觉减退部位、生活质量评分(QOL-BREF)等。结果对照组切除的ICBN在镜下观察未见神经细胞被癌组织侵犯,神经周围组织中未见癌组织浸润。试验组术后并发症发生率显著低于对照组(P<0.05),术后感觉功能障碍量化评分显著高于对照组(P<0.05),术后生活质量评分显著高于对照组(P<0.01)。试验组和对照组的术后感觉减退部位差异无统计学意义(P>0.05)。结论针对老年乳腺癌病人,行乳腺癌改良根治术中保留ICBN的术式临床安全,并可显著减少术后并发症和感觉功能障碍,提高老年病人的术后生活质量。Objective To investigate the safety of preseravting intercostobrachial nerves(ICBN) and its effect on postoperative complications in the elderly patients undergoing radical mastectomy.Methods A total of 49 elderly patients with breast cancer(aged≥60 years) who underwent modified radical mastectomy from February 2014 to February 2017 in Nanjing Hospital Affiliated to Nanjing Medical University(Nanjing First Hospital) were selected.In the experimental group,24 patients underwent modified radical mastectomy reserving ICBN.In the same period,25 elderly patients who underwent modified radical mastectomy were enrolled in the control group,and they underwent ICBN removal.The HE staining of ICBN and surrounding tissues in the control group was observed.The postoperative complication rate,quantitative score of sensory dysfunction,postoperative sensory loss,and quality of life score(QOL-BREF) were compared in the two groups.Results The ICBN in the control group showed no neuronal invasion under the microscope,and no cancer tissue infiltration was observedin the surrounding tissues.The incidence rate of postoperative complications in the experimental group was significantly lower,the postoperative sensory dysfunction score and the postoperative quality of life score were significantly higher than those in the control group(P<0.01).There was no significant difference in postoperative sensory loss between the experimental group and the control group(P>0.05).Conclusions For elderly patients with breast cancer, ICBN preservation in modified radical mastectomy is safe,and can significantly reduce postoperative complications and sensory dysfunction,and improve the postoperative quality of life.

关 键 词：乳腺癌 改良根治术 肋间臂神经 病理检查 并发症 

分 类 号：R655.8[医药卫生—外科学]