乳腺癌腋窝淋巴结清扫术中保留肋间臂神经的临床意义
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摘要
目的:比较乳腺癌腋窝淋巴结清扫术中保留肋间臂神经和切除肋间臂神经的术后情况,探讨乳腺癌腋窝淋巴结清扫术中保留肋间臂神经的临床意义。方法:将72例行腋窝淋巴结清扫术的患者分为两组。术后比较两组患者的手术时间,患者患侧上臂内侧、腋下等部位皮肤感觉功能,以及肿瘤局部复发及远处转移的情况。结果:两组手术所用时间比较保留组比切除组平均会增加手术用时10min(P<0.05)。术后2周、3个月、6个月对所有患者进行评估:保留组有感觉功能障碍者分别占该组人数的8.51%,2.13%和0.00%,而切除组有感觉功能障碍的分别占该组人数的88.00%、68.00%和40.00%,两者相比差异具有统计学意义(P<0.05)。结论:在对早期乳腺癌患者清扫腋窝淋巴结时保留肋间臂神经能显著的保存患者患侧上臂内侧、腋下等部位皮肤的感觉功能,有利于症状的短期内恢复,有效改善患者术后的生活质量,而且对肿瘤的局部复发、远处转移、短期生存率均无影响,因此具有较高的临床意义。
Objective:Comparison with the groups complexion after axillary lymph node dissection for breast cancer which the reserve ICBN group and the cut down ICBN group, To explore the value of Preservation of the intereostobraehial nerve during axillary lymph node dissection for breast cancer. Methods:The 72 patients with axillary lymph node dissection for breast cancer were divided into two groups. After the operation comparison with the sentience of the armpit and the complexion of the tumor diversion and recrudesce. Results:Comparison with the time of the two groups used,there was only 10 min by reserve ICBN in the operation(P <0.05). All of the patients emerged the pain and sensory disturbance in internal upper arm after operations. The reserve ICBN group was 8.51%, 2.13%and 0.00%; the cut down ICBN group was 88.00%, 68.00% and 40.00%.The degree and the duration of the pain and the sensory disturbance were different(P <0.05). Conclusion: It is feasible to reserved ICBN during axillary lymph node excision in the early breast cancer operation, and can significantly decrease the postoperative morbidity of arm pain and sensory disturbance. It is a good for increasing the life quality of patients after operation.
Objective:Comparison with the groups complexion after axillary lymph node dissection for breast cancer which the reserve ICBN group and the cut down ICBN group, To explore the value of Preservation of the intereostobraehial nerve during axillary lymph node dissection for breast cancer. Methods:The 72 patients with axillary lymph node dissection for breast cancer were divided into two groups. After the operation comparison with the sentience of the armpit and the complexion of the tumor diversion and recrudesce. Results:Comparison with the time of the two groups used,there was only 10 min by reserve ICBN in the operation(P <0.05). All of the patients emerged the pain and sensory disturbance in internal upper arm after operations. The reserve ICBN group was 8.51%, 2.13%and 0.00%; the cut down ICBN group was 88.00%, 68.00% and 40.00%.The degree and the duration of the pain and the sensory disturbance were different(P <0.05). Conclusion: It is feasible to reserved ICBN during axillary lymph node excision in the early breast cancer operation, and can significantly decrease the postoperative morbidity of arm pain and sensory disturbance. It is a good for increasing the life quality of patients after operation.
引文
[1]韩中保,周羽,韩扣兰.乳腺癌根治术保留肋间臂神经对患者术后生活质量的影响[J].中国临床解剖学杂志,2011,5(29):591-593.
[2]Granek I,Ashikari R,Foley KM.The Post mastectomy Pain syndrome clinical and anatomical correlates[J].Proc ASCO,1984;3(l):122.
[3]Vecht CJ,Van de Brand HJ,Wajer OJM.Post-axillary dissection pain in breast cancer due to a lesion of the intercostobrachial nerve[J].Pain,1989;38:171-176.
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[6]Abdullah TI,Iddon J,Barr L,et al.Prospective randomized controlled trial of preservation of the intercostobrachial nerve during axillary node clearance for breast canner[J].Br Surg,1998;85:1443-1445.
[7]Roses DF,Brooks AD,Harris MN,et al.Complications of level I and II axillary dissection in the treatment of carcinoma of the breast.Ann Surg,1999;230:194-201.
[8]耿中利,马斌林,王进,等.保留肋间臂神经在乳腺癌腋窝淋巴结清扫术中的意义[J].新疆医科大学学报,2009,32(7):842-844.
[9]陈伟财,何劲松,王敏,等.保留肋间臂神经在乳腺癌改良根治术中的临床意义[J].山西医科大学学报,2011,42(3):260-262.
[10]徐俊奇,胡永忠,胡小花.保留肋间壁神经在乳腺癌改良根治术中的应用[J].中华实用医刊,2009,36(18):30-31.
[11]钟广俊,周茂松,唐金海.乳腺癌改良根治术保留肋间壁神经的探讨[J].实用临床医药杂志,2009,13(11):108-110.
[12]邓军奇,李青云.在乳腺癌改良根治中保留肋间壁神经的临床意义[J].医学信息,2011,29(9):6067-6068.
[13]褚东明,龚强.朱薇婷,等.保留肋间臂神经的乳腺癌改良根治术[J].外科理论与实践,2011,16(4):403-404.
[14]周振宇,马明德,常亮.乳腺癌保乳手术中保留肋间壁神经的方法及临床疗效[J].中国实用医刊,2011,38(4):63-64.
[2]Granek I,Ashikari R,Foley KM.The Post mastectomy Pain syndrome clinical and anatomical correlates[J].Proc ASCO,1984;3(l):122.
[3]Vecht CJ,Van de Brand HJ,Wajer OJM.Post-axillary dissection pain in breast cancer due to a lesion of the intercostobrachial nerve[J].Pain,1989;38:171-176.
[4]Sobin LH,Wittekind C.TNM classification of malignant tumors 5thed[J].New York John Wiley and Sons Inc.1997;123-130.
[5]吴祥德,董守义.乳腺疾病诊治[M].北京:人民卫生出版社,2004:26.
[6]Abdullah TI,Iddon J,Barr L,et al.Prospective randomized controlled trial of preservation of the intercostobrachial nerve during axillary node clearance for breast canner[J].Br Surg,1998;85:1443-1445.
[7]Roses DF,Brooks AD,Harris MN,et al.Complications of level I and II axillary dissection in the treatment of carcinoma of the breast.Ann Surg,1999;230:194-201.
[8]耿中利,马斌林,王进,等.保留肋间臂神经在乳腺癌腋窝淋巴结清扫术中的意义[J].新疆医科大学学报,2009,32(7):842-844.
[9]陈伟财,何劲松,王敏,等.保留肋间臂神经在乳腺癌改良根治术中的临床意义[J].山西医科大学学报,2011,42(3):260-262.
[10]徐俊奇,胡永忠,胡小花.保留肋间壁神经在乳腺癌改良根治术中的应用[J].中华实用医刊,2009,36(18):30-31.
[11]钟广俊,周茂松,唐金海.乳腺癌改良根治术保留肋间壁神经的探讨[J].实用临床医药杂志,2009,13(11):108-110.
[12]邓军奇,李青云.在乳腺癌改良根治中保留肋间壁神经的临床意义[J].医学信息,2011,29(9):6067-6068.
[13]褚东明,龚强.朱薇婷,等.保留肋间臂神经的乳腺癌改良根治术[J].外科理论与实践,2011,16(4):403-404.
[14]周振宇,马明德,常亮.乳腺癌保乳手术中保留肋间壁神经的方法及临床疗效[J].中国实用医刊,2011,38(4):63-64.