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目的通过对支配胸肌神经及肋间臂神经的解剖学研究,设计一个合理的乳癌手术方式。方法利用10%的福尔马林固定的成年女性尸体10具(20侧),常规解剖方法解剖出胸上神经、胸内神经、胸外神经及肋间臂神经。临床行60例乳腺癌根治术(实验组、对照组各30例),实验组完全保留胸神经、肋间臂神经及乳头,术后检查两组病人胸肌的厚度、患侧上肢的感觉、肌力,并进行对照分析。结果临床实验组:患侧胸大肌厚度和患侧上臂内收肌力与健侧比较差异无显著性(P>0.01)。实验组术后发生上肢感觉障碍率6.7%、对照组63.9%.二者比较差异有显著性(P<0.01)。结论该术式对保护上肢功能,胸部美学及提高病人的生存质量, 有非常重要的意义,是一种治疗I,Ⅱ期乳腺癌合理有效的术式。
Objective To design a rational breast cancer surgery by anatomizing the dominant pectoral nerve and intercostobrachial nerve. Methods 10 adult cadavers (10 sides) were fixed in 10% formalin. The thoracic nerves, intrathoracic nerves, extrathoracic nerves and intercostobrachial nerves were anatomically dissected. Sixty cases underwent radical mastectomy (30 cases in experimental group and 30 cases in control group) respectively. The thoracic nerve, intercostal nerve and nipple in the experimental group were completely preserved. The thickness of the pectoral muscle, Force, and control analysis. Results In the clinical experimental group, there was no significant difference in the pectoralis major muscle thickness and contralateral upper arm adductor muscle strength between the experimental group and the contralateral side (P> 0.01). The rate of upper limb sensory disturbance was 6.7% in the experimental group and 63.9% in the control group, the difference was significant (P <0.01). Conclusion The procedure is very important for the protection of upper extremity function, chest aesthetics and quality of life of patients. It is a reasonable and effective procedure for the treatment of stage I and II breast cancer.