乳腺癌改良根治术中肋间臂神经保留的可行性与安全性分析

doi:10.3969/j.issn.10056483.2019.03.012

摘要/Abstract

摘要： 目的:探讨乳腺癌改良根治术中肋间臂神经保留的可行性与安全性。方法:乳腺癌改良根治术病人60例，按是否行肋间臂神经保留分成两组，试验组34例，术中对肋间臂神经进行保留；对照组26例，术中未行肋间臂神经保留。比较两组的手术及住院情况、感觉功能障碍量化评分、术后感觉改变部位、病人的生活质量评分（QOL）、并发症、随访1年的复发率。结果:试验组手术时间（110.45±27.53）min，术中出血量（115.76±23.13）ml、淋巴结清扫数目为（12.65±2.77）;对照组分别为（102.37±26.15）min、（108.55±21.49）ml 和（11.78±2.52），两组比较差异均无统计学意义（P>0.05）。试验组住院时间为（7.49±1.32）d，对照组为（8.42±1.45）d，两组比较差异有统计学意义（P<0.05）。试验组术后1个月、3个月、6个月的感觉功能障碍量化评分分别为（2.04±0.71）、（2.87±0.84）和（3.25±1.06），对照组分别为（1.63±0.54）、（2.12±0.72）和（2.56±0.93），差异有统计学意义（P<0.05）。试验组腋窝、上臂前侧、后侧、内侧、外侧的感觉改变率分别为14.71%、5.88%、11.76%、8.82%和2.94%，对照组分别为34.62%、26.92%、23.08%和30.77%、15.38%，两组比较差异有统计学意义（P<0.05）。试验组QOL总分为（41.35±6.84），对照组为（32.45±5.67）（P<0.05）。试验组并发症发生率为14.71%，对照组为11.54%，两组比较差异无统计学意义（P>0.05）。试验组随访1年的复发率为8.82%，对照组为7.69%，两组比较差异无统计学意义（P>0.05）。结论:乳腺癌改良根治术中保留肋间臂神经，可提高患者术后感觉功能，且对手术效果和并发症的发生无明显影响，具有较高的可行性与安全性。

关键词: 乳腺癌, 改良根治术, 肋间臂神经, 感觉功能, 并发症

Abstract: Objective:To study the feasibility and safety analysis of intercostal brachial nerve preservation in modified radical mastectomy for breast cancer.Methods:The data of sixty patients with modified radical mastectomy were retrospectively analyzed.Thirtyfour patients who underwent intraoperative intercostobrachial nerve preservation were set as the study group.Twentysix patients who did not had intercostal brachial nerve preservation during the operation were set as the control group.The situation of operation and hospitalization，the quantitative score of sensory dysfunctions，the location of postoperative sensory changes，quality of life score（QOL），complications and recurrence rate of one year followup for cancer patients were compared between the two groups.Results:The operation time of the experimental group（110.45±27.53）min，intraoperative blood loss（115.76±23.13）ml，lymph node dissection（12.65±2.77）and control group was（102.37±26.15）min，（108.55±21.49）ml and （11.78±2.52），respectively（P>0.05）.The length of hospital stays in the experimental group[（7.49±1.32）d] was significantly lower than that in the control group[（8.42±1.45）d]（P<0.05）.The quantitative scores of sensory dysfunctions in the experimental group at 1 month，3 months，and 6 months were（2.04±0.71），（2.87±0.84），and（3.25±1.06），respectively，which were significantly higher than those in the control group[（1.63±0.54），（2.12±0.72） and （2.56±0.93），respectively]（P<0.05）.The sensory change rates of the axilla，anterior，posterior，medial and lateral sides of the experimental group were 14.71%，5.88%，11.76%，8.82%，and 2.94%，respectively，which were significantly lower than those of the control group[34.62%，26.92%，23.08%，30.77%，15.38%]（P<0.05）.The total score of QOL in the experimental group（41.35±6.84）was significantly higher than that in the control group（32.45±5.67）（P<0.05）.The incidence of complications in the experimental group was 14.71%，which was not significantly different from the complication rate in the control group（11.54%）（P>0.05）.The recurrence rate of the experimental group was 8.82% with one year，and the recurrence rate of the control group was 7.69%.The difference was not statistically significant（P>0.05）.Conclusion:Retaining the intercostal brachial nerve during modified radical mastectomy for breast cancer can effectively improve postoperative sensory function，and has no significant effect on the surgical outcome and complications.It has high feasibility and safety，and can be based on the degree of tumor progression to flexible use.

Key words: breast cancer, modified radical, intercostobrachial nerve, sensory function, complications

朱加猛. 乳腺癌改良根治术中肋间臂神经保留的可行性与安全性分析[J]. 临床外科杂志, 2019, 27(3): 214-217.

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