乳腺癌腋清扫术中保留肋间臂神经临床应用.docVIP

乳腺癌腋清扫术中保留肋间臂神经临床应用[摘要]目的探讨乳腺癌腋窝淋巴结清扫术时保留肋间臂神经(ICBN)的方法及临床意义。方法 在59例乳腺癌腋窝清扫术中施行保留肋间臂神经44例,切除肋间臂神经15例。全部患者均按照乳腺癌临床指南治疗,并对59例患者上臂内侧及腋下感觉功能进行随访观察。结果 肋间臂神经保留组术后44例中术后患侧上臂内侧及腋下皮肤感觉正常37例(84%)感觉异常7例(15.9%),所有患者术后12个月均未发生局部复发及转移。结论 在乳腺癌腋窝清扫术中保留肋间臂神经,可明显降低术后 患侧上臂内侧及以下感觉障碍的发生率,有助于提高患者的生活质量。 [关键词]乳腺癌; 肋间臂神经; 腋窝清扫术 [中图分类号] R737.9[文献标识码]A [文章编号] 1005-0515(2010)-9-052-02 [Abstract]ObjectiveTo evaluate the method and clinical significance ofthe retainment of the intercostobrachial nerve (ICBN) when resection of axillary lymph nodes. Methods In 59 patients with resection of axillary lymph nodes, 44 cases preserving the intercostobrachial nerve, 15 cases resection of the intercostobrachial nerve. All patients were treated in accordance with the clinical guidelines of breast cancer, and 59 patients were follow-up serveyed for the sensory functions of the inside of upper arm and oxter. Resultsthe skin felling of the inside of upper arm and oxter in the 44 cases with the retainment of the intercostobrachial nerve after resection of axillary lymph nodes, normal in 37 ases (84%) , and in 7 cases (15.9%).After 12 months , all patients occur local recurrence and metastasis. Conclusion The retainment of the intercostobrachial nerve when resection of axillary lymph nodes will reduce the probability of the postoperative sensory dysfunction,and improve the quality of life of patients [Keywords]breast cancer;intercostobrachial nerve;axillary dissection 近年来,随着乳腺癌生物学研究的加深,乳腺癌外科手术范围不断缩小,由于传统改良根治术腋窝淋巴结清扫术中保留胸长神经,胸背神经的重要性已被普遍认可而对保留肋间臂神经认识不足,重视不够,在绝大多数腋窝淋巴结清扫术中,ICBN被常规切除,从而导致术后上臂内侧及腋下感觉异常、疼痛。但近年来患者对术后生活质量要求不断提高。我科自2007.10至2009.8期间对59例乳腺癌患者施行保留ICBN44例现总结分析如下: 1 资料与方法 1.1 一般资料 本组59例患者均为女性,年龄29-73岁,中位年龄47.5岁,0期1例,Ⅰ期24例,Ⅱ期32例,Ⅲ期2例。其中浸润性导管癌48例,导管内癌1例,浸润性小叶癌7例,髓样癌2例 1.2 手术方式改良根治术57例,标准乳腺癌根治术2例。行腋窝淋巴结清扫时,显露腋静脉,先清除腋静脉周围淋巴结及脂肪组织,然后顺胸壁由上而下清扫,于胸小肌外侧缘后方与第二肋间隙交界可见一直径约1.2-2.2mm的横行神经索穿出肋间,走行与胸长神经相垂直,此即ICBN。切开脂肪囊可显示其存在,顺其走向向近端可找到该神经起始部,而远端可达神经入上臂处,妥善保护之,在其深面继续清扫。 2结果 44例于术中成功保留肋间臂神经,