乳腺癌改良根治术后胸大肌功能肌电评估.docVIP

乳腺癌改良根治术后胸大肌功能肌电评估 　 作者：张士淮，康骅，王玉平　骆成玉，海涛 ［摘要］ 目的 评价乳腺癌不同改良根治术后胸大肌功能的变化，并应用肌电对其进行评估，同时探讨保留胸前神经在乳腺癌改良根治术中的意义。方法 从2001年1月～2003年12月在我院行乳腺癌改良根治术的患者46例，术后3个月以上应用肌电图对胸大肌功能进行检测。结果 未完整保留胸前神经组患侧与健侧胸前神经动作电位波幅和传导速度均存在明显差异，表现为患侧胸前神经动作电位波幅减小［（0.68±0.65）μV vs（1.35±0.83）μV，P=0.017）］，传导速度减慢［（45.55±16.03）m/s vs（54.45±17.40）m/s，P=0.02）］；未完整保留胸前神经组其潜伏期延长，动作电位波幅减低及传导速度减慢。Auchincloss术组内患侧胸前神经的潜伏期与健侧对比出现延长［（2.94±1.14）ms vs（2.60±0.67）ms，P＜0.05）］。结论 在乳腺癌改良根治术中，不论是Auchincloss手术，还是Patey手术均可能导致术后胸大肌功能状态改变。本研究提示当应用肌电图对胸大肌功能检测时，只需测定胸前神经的潜伏期、动作电位波幅及传导速度即可，同时也提示在乳腺癌改良根治术中有意识地保护胸前神经的重要性，这也是保证术后胸大肌的功能关键所在。 ［关键词］ 乳腺癌；乳腺癌改良根治术；胸大肌；胸前神经；肌电图 ［Abstract］ Objective To evaluate the pectoralis major muscles function after different modified radical mastectomy by electromyogram and explore the significance of preserving the anterior thoracic nerve in modified radical mastectomy.Methods Forty-six patients with breast cancer who had undergone modified radical mastectomy were included from Jan 2001 to Dec 2003.The function of the pectoralis major muscle was evaluated by using electromyogram 3 months or more after surgery.Results The motion potential amplitude of anterior thoracic nerve of the operated-side was decreased［（0.68±0.65)μV vs（1.35±0.83）μV，P=0.017）］ and the conduct velocity also became slower［（45.55±16.03）m/s vs（54.45±17.40）m/s，P=0.02）］compared with normal-side in incompletely preserved anterior thoracic nerve group.The latent period was delayed，the motion potential amplitude was decreased and the conduct velocity became slower in the incompletely preserved anterior thoracic nerve group.The latent period of operated-side was delayed compared with the normal-side in Auchincloss’s operation group［（2.94±1.14）ms vs（2.60±0.67）ms，P＜0.05）］.Conclusion The modified radical mastectomy including Auchinclosss operation and Patey’s operation could result in damage to the function of the pectoralis major muscle.When electromyogram is used to examine the function of the pectoralis major muscle，we recommend that t