乳腺癌保乳手术中保留胸前神经和肋间臂神经的意义
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鲁建国E-mail:lujianguo@fmmu.edu.cn

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Significance of preserving anterior thoracic nerve and intercostobrachial nerve during breast-conserving operation for breast cancer
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    摘要:

    目的:探讨乳腺癌保乳手术中保留胸前神经(ATN)和肋间臂神经(ICBN)的方法及意义。
    方法:回顾近5年间乳腺癌行保乳术的382例患者病历资料。保留ATN及ICBN者312例,切断ATN及ICBN者70例。术后随访观察胸大小肌萎缩情况和患侧腋窝、上臂内侧的感觉异常情况。
    结果:保留ATN及ICBN患者患侧腋部及上臂内侧皮肤感觉正常占80.4%(251/312),感觉异常占19.6% (61/312),且多可在2~3个月内恢复;术后3个月胸肌无明显萎缩,外形良好,患肢负重运动良好。切断ATN及ICBN的70例患者仅16例(22.9%)感觉正常,54例(77.1%)有不同程度的感觉异常,主要表现为患侧腋窝、上臂内侧及肩胛下部位的疼痛、麻木、酸胀、蚁行感和烧灼感等;术后3个月患侧胸肌不同程度萎缩及上肢活动障碍、功能减退。
    结论:乳腺癌保乳术中保留ATN及ICBN是可行的,可有效减少患侧腋部及上肢感觉异常和胸肌萎缩的发生率,改善患者术后生活质量。

    Abstract:

    Objective:To study the method and significance of preserving anterior thoracic nerve (ATN) and intercostobrachial nerve (ICBN) during breast-conserving operation for breast cancer.
    Methods:A total of 382 cases with breast-conserving operation for breast cancer in recent 5 years were reviewed. In 312 cases the opeeration was performed by preserving ATN and ICBN, and in 70 cases the ATN and ICBN were not preserved. The patients were followed-up postoperatively.
    Results:Among the patients whose operation was performed by preserving ATN and ICBN, skin sensation of armpit and upper arm was normal in 80.4%(251/312)  and abnormal in 19.6% (61/312) of patients, but in most of them, it recovered in 2-3 months. Among the patients with out preservation of ATN and ICBN, skin sensation was normal in only 16 cases(22.9%), and had varying degrees of abnormal sensation in 54 cases(77.1%).
    Conclusions:Preservation of ATN and ICBN during breast-conserving surgery for breast cancer is feasible, can decrease the incidence of hypoesthesia of axilla and upper arm and atrophy of pectoralis muscles, and the quality of life of patients after operation is improved.

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李金茂| 鲁建国| 何显力| 刘媛媛.乳腺癌保乳手术中保留胸前神经和肋间臂神经的意义[J].中国普通外科杂志,2010,19(5):482-485.
DOI:10.7659/j. issn.1005-6947.2010.05.007

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  • 收稿日期:2010-01-05
  • 最后修改日期:2010-04-17
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  • 在线发布日期: 2010-05-15