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目的探讨保留肋间臂神经在乳腺癌改良根治术中的应用及意义。方法选取Ⅰ、Ⅱ期女性乳腺癌患者92例,均行保留胸大肌和胸小肌的乳腺癌改良根治术,术中常规保留胸长神经和胸背神经。92例患者分为两组,术中保留肋间臂神经56例(A组),术中切除肋间臂神经36例(B组)。两组术后均给予常规放化疗及内分泌等综合治疗。比较两组手术时间、淋巴结清扫数,术后患侧上肢感觉异常、疼痛及原位复发率。结果两组均顺利完成手术,术后随访1~3年。两组手术时间及术中清扫淋巴结数差异无统计学意义(P>0.05);术后1年,A组术后上肢感觉障碍发生率低于B组(17.68%vs.80.56%)(P<0.01);A组术后上肢疼痛发生率低于B组(10.71%vs.36.11%)(P<0.01)。随访期间,两组局部复发率差异无统计学意义(P>0.05)。结论乳腺癌根治术中肋间臂神经的保留,能够降低患侧肢体的感觉障碍,提高术后生存质量,且不延长手术时间,不增加肿瘤的复发。
Objective To explore the application and significance of preserving intercostobrachial nerve in modified radical mastectomy for breast cancer. Methods Ninety-two patients with stage I and II breast cancer were selected. All the patients underwent modified radical mastectomy for breast cancer with retained pectoralis major and pectoralis minor muscles. The thoracodorsal nerve and thoracodorsal nerve were routinely preserved during operation. Ninety-two patients were divided into two groups. Fifty-six patients (group A) with intercostobrachial nerves were reserved and 36 patients with intercostobrachial nerve resection (group B) during operation. Both groups were given conventional radiotherapy and chemotherapy and endocrine and other comprehensive treatment. The operation time, number of lymph node dissection, abnormal sensation of upper extremity, pain and in situ recurrence were compared between the two groups. Results The two groups were successfully completed the operation, followed up for 1 to 3 years. There was no significant difference between the two groups in the operation time and the number of lymph nodes in operation (P> 0.05). The incidence of postoperative upper limb sensory disturbance in group A was lower than that in group B (17.68% vs.80.56%, P < 0.01). The incidence of postoperative upper limb pain in group A was lower than that in group B (10.71% vs.36.11%, P <0.01). During follow-up, there was no significant difference in the local recurrence rates between the two groups (P> 0.05). Conclusion The preservation of intercostobrachial nerve in radical mastectomy can reduce the sensory disturbance of the affected limbs and improve the quality of postoperative life without prolonging the operation time and without increasing the recurrence rate of the tumor.