摘要
目的探讨乳腺癌手术中采用溶脂法保留肋间臂神经的方法及临床意义。方法总结分析我院2013年1月至2013年6月50例Ⅰ~Ⅲa期乳腺癌患者的临床资料,将50例患者随机分为2组,其中保留组26例患者行腋窝淋巴结清扫时,采用溶脂方法完整保留肋间臂神经,切除组24例按照常规方法行腋窝淋巴结清扫,未保留肋间臂神经,比较2组手术时间、术中出血量、术后淋巴结清扫数量及患者上臂感觉功能情况。结果保留组手术时间为（102.3±15.6）min,淋巴结清扫数量为（19.5±8.8）枚;切除组手术时间为（95.6±12.4）min,淋巴结清扫数量为（19.2±9.5）枚,2组比较差异无统计学意义（P〉0.05）。保留组与切除组术中出血量分别为（51.2±11.5）m L与（98.5±13.4）m L,2组间比较差异有统计学意义（P〈0.05）。术后1月观察患者上臂感觉功能情况,保留组患者中3例患者出现皮肤麻木、疼痛,占11.5%;切除组患者中20例出现不同程度的皮肤感觉异常,占83.3%,主要表现为感觉减退、麻木、疼痛及烧灼感,2组比较差异有统计学意义（P〈0.05）。所有患者随访半年后,保留组患者感觉异常症状均恢复,而切除组恢复不明显,仍表现不同程度的感觉异常,所有患者均未局部复发或远处转移。结论乳腺癌术中溶脂辅助保留肋间臂神经是在常规方法的基础上做了改进,操作方便,简单可行,腋窝血管神经更加清晰,保留肋间臂神经更加容易,且并未影响腋窝淋巴结清扫及手术时间。该方法降低了术后患侧上臂感觉异常的发生率,提高了患者生活质量,值得临床推广应用。
Objective To study the method and clinical value of preservation of intercostobrachial nerve（ ICBN） by fat dissolving method during breast cancer operation. Methods The clinical data of 50 cases with Ⅰ - Ⅲa stage breast cancer from January 2013 to June 2013 were analyzed. Fifty patients were randomly divided into two groups,there were 26 patients in preservation group,whose ICBN were preserved by fat dissolving method during axillary lymph nodes dissection,and 24 patients in resection group,whose ICBN were not preserved by routine method during axillary lymph nodes dissection. Comparison of operation times,bleeding volume,the number of axillary lymph nodes dissection and upper arm sensory function of patients after operation between both groups was done. Results The mean time of operation was（ 102. 3 ± 15. 6） min in preservation group and（ 95. 6 ± 12. 4） min in resection group,while the number of axillary lymph nodes dissection was（ 19. 5 ± 8. 8） in preservation group and（ 19. 2 ± 9. 5） in resection group,with no significant difference between both groups（ P〉 0. 05）. Bleeding volume was（ 51. 2 ± 11. 5） m L in preservation group and（ 98. 5 ± 13. 4） m L in resection group,with significant differences（ P 〈0. 05）. After postoperative one month,we observed upper arm sensory function of patients. It showed that 3 cases of sensory numbness or pain occurred in preservation group（ 11. 5%）,20 cases of sensory abnormality occurred in resection group（ 83. 3%）,mainly as sensory loss,numbness,pain or burning sensation,there was significant difference between both groups（ P 〈0. 05）. All patients were followed up half a year,patients with sensory abnormality in preservation group recovered,and recovery in resection group was not obvious,it still showed sensory abnormality in varying degrees. During the follow-up,no local recurrence or distant metastasis was found in both groups. Conclusion Preserving intercostobrachial nerve by fat dissolving method in breast cancer
出处
《局解手术学杂志》
2015年第4期432-434,共3页
Journal of Regional Anatomy and Operative Surgery
关键词
乳腺癌
根治术
肋间臂神经
溶脂法
感觉异常
breast cancer
radical mastectomy
intercostobrachial nerve
fat dissolving method
sensation abnormality
