保留肋间臂神经在Ⅰ、Ⅱ期乳腺癌手术中的临床价值
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摘要
目的探讨保留肋间臂神经在乳腺癌改良根治术中的方法及临床价值。方法回顾性分析86例行乳腺癌改良根治术的Ⅰ、Ⅱ期乳腺癌患者,随机分为两组,观察组和对照组各43例,观察组术中保留肋间臂神经,对照组术中切除肋间臂神经,进行12~36个月的随访观察,比较两组患者术后上臂内侧和腋窝皮肤感觉功能、术后皮下积液、皮瓣坏死及腋窝局部复发情况。结果观察组患者术后患侧上臂内侧及腋窝皮肤感觉异常4例(9.3%),对照组患者感觉异常41例(95.3%),观察组明显优于对照组患者(P<0.01)。两组患者手术时间、术中出血、术后并发症及腋窝复发情况比较,差异无统计学意义(P>0.05)。结论保留肋间臂神经在Ⅰ、Ⅱ期乳腺癌患者改良根治术中可以减少上臂、腋窝皮肤感觉异常的发生,提高了患者术后的生活质量,值得临床推广应用。
Objective To explore the methods and clinical value of reserving intercostobrachial nerve in modified radical mastectomy for breast cancer.Methods 86 patients of breast cancer at stage Ⅰ,Ⅱ undergoing modified radical mastectomy were randomly divided into observation group(43 cases) and control group(43 cases).The intercostobrachial nerves were preserved in observation group,while resected in control group.The postoperative sensory functions of interior upper arms and axilla skin,seroma,flap necrosis and axillary local recurrence were tracked for 12~36 months and compared between the two groups.Results 4 patients(9.3%) of the observation group and 41 patients(95.3%) of the control group had abnormal sensation at the interior upper arms and axilla skin; the observation group was better than control group(P<0.01).The operation time,intraoperative bleeding and postoperative complications and axillary relapse between the two groups had no statistical significance(P>0.05).Conclusions Reserving intercostobrachial nerve in modified radical mastectomy for breast cancer at stage Ⅰ,Ⅱ can reduce the occurrence of abnormal sensory and impairment in skins of upper and axillary,and improve the postoperative quality of life,so it is worthy of clinical application and popularization.
Objective To explore the methods and clinical value of reserving intercostobrachial nerve in modified radical mastectomy for breast cancer.Methods 86 patients of breast cancer at stage Ⅰ,Ⅱ undergoing modified radical mastectomy were randomly divided into observation group(43 cases) and control group(43 cases).The intercostobrachial nerves were preserved in observation group,while resected in control group.The postoperative sensory functions of interior upper arms and axilla skin,seroma,flap necrosis and axillary local recurrence were tracked for 12~36 months and compared between the two groups.Results 4 patients(9.3%) of the observation group and 41 patients(95.3%) of the control group had abnormal sensation at the interior upper arms and axilla skin; the observation group was better than control group(P<0.01).The operation time,intraoperative bleeding and postoperative complications and axillary relapse between the two groups had no statistical significance(P>0.05).Conclusions Reserving intercostobrachial nerve in modified radical mastectomy for breast cancer at stage Ⅰ,Ⅱ can reduce the occurrence of abnormal sensory and impairment in skins of upper and axillary,and improve the postoperative quality of life,so it is worthy of clinical application and popularization.
引文
[1]孙孟青,王梅香.乳腺癌手术期个性化心理护理研究[J].护理实践与研究,2011,8(5):116-117.
[2]吴维敏,余书勇,尹俊峰,等.乳腺癌改良根治术保留肋间臂神经72例临床价值分析[J].海南医学院学报,2010,16(6):739-741,743.
[3]夏根玉,王翠兰,蔡昌龙,等.乳腺癌改良根治术与乳腺癌根治术的比较[J].临床医学工程,2012,19(7):1140-1141.
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[5]Granek I,Ashikari R,Foley K.The post-mastectomy pain syndrome:Clinical and anatomical correlates[J].Proc Am Soc Clin Oncol,1984,3(1):122.
[6]李新苹.保留肋间臂神经的乳腺癌改良根治术60例疗效观察[J].实用临床医药杂志,2012,16(23):79-80,83.
[7]徐俊奇,胡永忠,胡小花,等.保留肋间臂神经在乳腺癌改良根治术中的应用[J].中国实用医刊,2009,36(18):30-31.
[8]印国兵,吴诚义.肋间臂神经与肋间臂神经综合征[J].中国肿瘤临床,2005,32(5):298-300.
[9]刘忠臣,刘晓东,董新舒,等.保留相关功能神经的改良乳腺癌根治术[J].中华普通外科杂志,2004,19(1):27-29.
[10]赵延峰,黎辉,蒋国旭.保留肋间臂神经在乳腺癌改良根治术中的应用及临床意义[J].白求恩军医学院学报,2009,7(4):207-208.
[2]吴维敏,余书勇,尹俊峰,等.乳腺癌改良根治术保留肋间臂神经72例临床价值分析[J].海南医学院学报,2010,16(6):739-741,743.
[3]夏根玉,王翠兰,蔡昌龙,等.乳腺癌改良根治术与乳腺癌根治术的比较[J].临床医学工程,2012,19(7):1140-1141.
[4]朱江,魏斌.乳腺癌改良根治术中保留肋间臂神经的临床应用[J].基层医学论坛,2011,15(1):17-18.
[5]Granek I,Ashikari R,Foley K.The post-mastectomy pain syndrome:Clinical and anatomical correlates[J].Proc Am Soc Clin Oncol,1984,3(1):122.
[6]李新苹.保留肋间臂神经的乳腺癌改良根治术60例疗效观察[J].实用临床医药杂志,2012,16(23):79-80,83.
[7]徐俊奇,胡永忠,胡小花,等.保留肋间臂神经在乳腺癌改良根治术中的应用[J].中国实用医刊,2009,36(18):30-31.
[8]印国兵,吴诚义.肋间臂神经与肋间臂神经综合征[J].中国肿瘤临床,2005,32(5):298-300.
[9]刘忠臣,刘晓东,董新舒,等.保留相关功能神经的改良乳腺癌根治术[J].中华普通外科杂志,2004,19(1):27-29.
[10]赵延峰,黎辉,蒋国旭.保留肋间臂神经在乳腺癌改良根治术中的应用及临床意义[J].白求恩军医学院学报,2009,7(4):207-208.