Ⅰ、Ⅱ期乳腺癌腋窝淋巴结清扫术中保留肋间臂神经的临床研究

摘要

Objective:To investigate the feasibility and clinical value of preserving intercostobrachial nerve( inter-costobrachial nerve,ICBN)in the breast cancer during modified radical mastectomy of breast cancer axillary lymph node dissection. Methods:85 cases of Ⅰ,Ⅱ breast cancer patients were selected randomly with modified radical mastectomy of breast cancer axillary lymph node dissection. 43 cases with a view were retained the integrity of the ICBN selection of patients and 42 cases with a view were resected the ICBN selection of patients. Compared the two groups of patients of the operation time,bleeding volume,the number of intraoperative lymph node dissection and post-operative 1 month,2 months,6 months observation of areas affected arm paresthesia,the happening of pain. Results:The operative time(Z= -0. 0314,P=0. 754),blood loss(Z= -1. 068,P=0. 285)and number of lymph node dis-section(Z= -0. 477,P=0. 633)of the retained group were no significant difference compared with the resection group. The sensory disturbances in the two groups with incidence of abnormal side armpit and the inside of the upper arm after 3 days had no significant difference(P=0. 180). The upper area of the sKin after paresthesia had a sig-nificant difference after 1 month(P=0. 000),2 months(P=0. 000),6 months(P=0. 000). The remission rate of the sKin of postoperative patients with sensory disturbances of arm area after 1,2 and 6 months were P=0. 000,P=0. 000,P=0. 000,and had a significant difference. The pain of the patients with arm area had a significant difference after 1 month(P=0. 000),2 months(P=0. 005),6 months(P=0. 006). The remission rate of the sKin of postop-erative patients with the pain of the patients with arm area had a significant difference after 6 months(P=0. 000). Conclusion:Retaining the intercostobrachial nerve does not increase the difficult surgery in modified radical mastecto-my of breast cancer for the stageⅠ,Ⅱbreast cancer. It could significantly reduce the incidence of the upper arm area of the sKin paresthesia,pain. It can also improve the quality of the patients,may be worthy of clinical application.%目的：探讨保留肋间臂神经（ intercostobrachial nerve，ICBN）在乳腺癌改良根治腋窝淋巴结清扫术中的可行性及临床应用价值。方法：随机选取85例施行乳腺癌改良根治腋窝淋巴结清扫术的Ⅰ、Ⅱ期乳腺癌患者。完整保留ICBN的患者43例，切除ICBN的患者42例，比较两组患者的手术时间、出血量、清扫淋巴结数目，术后1个月、2个月、6个月观察患侧腋窝及上臂内侧区的皮肤感觉异常、疼痛的发生及转归。结果：保留肋间臂神经组与非保留组比较，手术时间（Z=-0.0314，P=0.754）、出血量（Z=-1.068，P=0.285）、淋巴结清扫数目（ Z=-0.477，P=0.633），差异无统计学意义。保留组及非保留组在术后第3天患侧腋窝及上臂内侧的感觉异常发生率，差异无统计学意义（ P=0.180）。而术后腋窝及上臂内侧区的皮肤感觉异常术后1个月（P=0.000）、术后2个月（P=0.000）、术后6个月（P=0.000），术后1个月、2个月、6个月患侧腋窝及上臂内侧区皮肤感觉异常的完全缓解率均为P=0.000，患侧上肢疼痛发生率术后1个月（P=0.000）、术后2个月（P=0.005）、术后6个月（P=0.006），术后6个月患侧上肢疼痛的完全缓解率P=0.000，差异有统计学意义。结论：Ⅰ、Ⅱ期乳腺癌改良根治腋窝淋巴结清扫术中保留肋间臂神经的术式不增加手术难度，减少了患者术后患侧上臂的皮肤感觉异常及疼痛的发生率，改善患者术后的生活质量，具有一定的临床应用价值。