乳腺癌腋清扫术中保留肋间臂神经方法及临床意义.docVIP

乳腺癌腋清扫术中保留肋间臂神经方法及临床意义 　 作者：杨志刚，曹伟，章骏，周咸亮 【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 242例Ⅰ、Ⅱ期乳腺癌患者，随机分为两组，试验组（121例）行乳腺癌腋窝淋巴结清扫术时保留ICBN，对照组（121例）手术时不保留ICBN，全部患者均按乳腺癌临床指南治疗，并进行观察随访。结果 试验组及对照组术后上臂内侧和腋下感觉异常发生率分别为15.7%及79.3%（Plt;0.01），疼痛的发生率分别为9.1%及32.2%（Plt;0.01），差异有明显统计学意义；所有患者术后12个月中均未发生局部复发。结论 乳腺癌腋窝淋巴结清扫术时保留ICBN可以明显减少术后患侧上臂内侧和腋下感觉异常及疼痛，Ⅰ、Ⅱ期乳腺癌腋窝淋巴结清扫术中保留ICBN是必要和可行的。 【关键词】 乳腺癌；肋间臂神经；淋巴结切除术 The methods and clinical significance of preserving intercostobrachial nerve during axillary lymph nodes dissection for breast carcinoma ［Abstract］ Objective To study the methods and the clinical significance of preserving intercostobrachial nerve （ICBN） during the axillary lymph nodes dissection （ALND） for breast carcinoma.Methods Two hundred and forty-two cases of stages Ⅰ，Ⅱbreast carcinoma were divided into experimental group and control group respectively.The intercostobrachial nerves were preserved in experimental group and not in control group.All patients were treated following the practice guideline of breast carcinoma，and were followed up.Results The postoperative abnormal sense on the skin of the medial upper arm and/or axilla was 15.7% in the experimental group，which was significantly different from that of the control group 79.3%（Plt;0.01），and the incidence of pain is 9.1% in experimental group，which was also significantly different from that of control group 32.2%（Plt;0.01）.During twelve months after operation，all patients showed no relapse.Conclusion Preserving intercostobrachial nerves may significantly decrease the postoperative abnormal sense and pain on the skin of the medial upper arm and/or axilla during the axillary lymph nodes dissection （ALND） for breast carcinoma.It is necessary and advisable to preserve intercostobrachial nerve （ICBN） during the axillary lymph nodes dissection （ALND） for stage Ⅰ，Ⅱbreast carcinoma. ［Key words］ breast neoplasms；intercostobrachial nerves；lymph node excision 一个多世纪以来，乳腺癌的外科治疗经历了从理论认识到手术方式的重大转变，乳腺癌外科手术范围不断缩小。乳腺癌主要手术方式已经从H