溶脂辅助保留肋间臂神经在乳腺癌术中的临床意义

摘要

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 94 cases of breast cancer from January 2012 to January 2013 were analyzed retrospectively. 94 patients were randomly divided into two groups,there were 50 patients in modified group,whose ICBN were preserved by fat dissolving method during axillary lymph nodes dissection,and 44 patients in control group,whose ICBN were preserved by routine method during axillary lymph nodes dissection. We recorded the operation times,the number of axillary lymph nodes dissection,bleeding volume, upper arm sensory function,wound flushing fluid exfoliative cytological examination and follow - up results in both groups. Results:ICBN trunk was intactly preserved in all patients,ICBN branch of 1 case was cut off in modified group and varying degrees of ICBN branch damage and electric burn of 3 cases in control group. After postoperative three weeks,we observed upper arm sensory function of patients. It showed that 2 cases of sensory numbness in modi-fied group(4. 0% ),5 cases of sensory abnormality occurred in control group(11. 4% ),mainly as sensory loss, numbness,burning sensation and pain,there was no significant difference between both groups(P > 0. 05). There were significant differences among the data of operation times,number of lymph nodes dissection and bleeding volume in both groups(t = 12. 475,5. 648,10. 631,all P < 0. 05). All patients were followed up for half a year,patients with sensory abnormality recovered. No local recurrence or distant metastasis was found in both groups after 18 ~ 30 months follow - up. Wound flushing fluid exfoliative cytological examination found that there was no atypical cell in modified group. Conclusion:Preserving intercostobrachial nerve by fat dissolving method in breast cancer operation is based on conventional operation and made a few of improvements. It is simple and feasible. During the operation,we find that the axillary neurovascular is clearer,preservation of ICBN is easier,lymph node dissection is more complete,bleeding volume is less,operation time is shorter and postoperative recovery is faster. It is worthy of clinical application.%目的：探讨乳腺癌手术中溶脂辅助保留肋间臂神经的方法及临床意义。方法：回顾性分析我院2012年1月至2013年1月94例乳腺癌患者临床资料，将94例患者随机分为两组，改良组和对照组。其中改良组50例患者腋窝先经过溶脂后，再行保留肋间臂神经的腋窝淋巴结清扫，对照组44例患者按照常规方法行保留肋间臂神经的腋窝淋巴结清扫，记录两组手术时间、术中淋巴结清扫数量及出血量，观察术后患者上臂感觉功能情况，记录创面冲洗液脱落细胞学检查及随访结果。结果：两组患者术中肋间臂神经主干均完整保留，改良组1例肋间臂神经所属分支被离段，对照组3例出现不同程度肋间臂神经下支、分支离段及电灼伤。术后3周观察患者上臂感觉功能情况，改良组患者中2例出现皮肤麻木，占4.0％；对照组患者中5例出现不同程度的皮肤感觉异常，占11.4％，主要表现为感觉减退、麻木、烧灼感及疼痛，两组比较差异无统计学意义（P ＞0.05）。两组患者在手术时间、清扫淋巴结数目及出血量之间比较差异均有统计学意义（t 分别为12.475，5.648，10.631，均 P ＜0.05）。所有患者随访半年后感觉异常症状均恢复，随访18~30个月未出现局部复发或远处转移，改良组创面冲洗液脱落细胞学检查未见异型细胞。结论：乳腺癌手术中应用溶脂技术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，使腋窝血管神经更加清晰，保留肋间臂神经更加容易，而且清扫腋窝淋巴结更彻底，出血量少，缩短了手术时间，患者术后恢复更快，具有一定的临床应用价值，值得推广应用。