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目的:探讨保留肋间臂神经(intercostobrachial nerve,ICBN)在乳腺癌改良根治腋窝淋巴结清扫术中的可行性及临床应用价值。方法:随机选取85例施行乳腺癌改良根治腋窝淋巴结清扫术的Ⅰ、Ⅱ期乳腺癌患者。完整保留ICBN的患者43例,切除ICBN的患者42例,比较两组患者的手术时间、出血量、清扫淋巴结数目,术后1个月、2个月、6个月观察患侧腋窝及上臂内侧区的皮肤感觉异常、疼痛的发生及转归。结果:保留肋间臂神经组与非保留组比较,手术时间(Z=-0.0314,P=0.754)、出血量(Z=-1.068,P=0.285)、淋巴结清扫数目(Z=-0.477,P=0.633),差异无统计学意义。保留组及非保留组在术后第3天患侧腋窝及上臂内侧的感觉异常发生率,差异无统计学意义(P=0.180)。而术后腋窝及上臂内侧区的皮肤感觉异常术后1个月(P=0.000)、术后2个月(P=0.000)、术后6个月(P=0.000),术后1个月、2个月、6个月患侧腋窝及上臂内侧区皮肤感觉异常的完全缓解率均为P=0.000,患侧上肢疼痛发生率术后1个月(P=0.000)、术后2个月(P=0.005)、术后6个月(P=0.006),术后6个月患侧上肢疼痛的完全缓解率P=0.000,差异有统计学意义。结论:Ⅰ、Ⅱ期乳腺癌改良根治腋窝淋巴结清扫术中保留肋间臂神经的术式不增加手术难度,减少了患者术后患侧上臂的皮肤感觉异常及疼痛的发生率,改善患者术后的生活质量,具有一定的临床应用价值。
Objective: To investigate the feasibility and clinical value of preserving intercostobrachial nerve (ICBN) in modified radical axillary lymph node dissection in breast cancer. Methods: A total of 85 patients with stage Ⅰ and Ⅱ breast cancer undergoing radical mastectomy and axillary lymph node dissection of breast cancer were randomly selected. 43 intact ICBN patients and 42 patients with ICBN were resected. The operation time, blood loss and number of lymph nodes were compared between the two groups. The axillary and medial upper arm were observed at 1 month, 2 months and 6 months after operation Area of skin abnormalities, the occurrence of pain and outcome. Results: The operative time (Z = -0.0314, P = 0.754), bleeding amount (Z = -1.068, P = 0.285), number of lymph node dissection (Z = -0.477, P = 0.633), the difference was not statistically significant. The incidence of sensory abnormalities in the axillary and upper medial arm of the reserved group and the non-reserved group on the 3rd day after operation showed no significant difference (P = 0.180). (P = 0.000), 2 months postoperatively (P = 0.000), 6 months postoperatively (P = 0.000), 1 month postoperatively , 2 months, 6 months, the affected side of the axillary and upper arm medial fenestration rate of complete remission rate was P = 0.000, ipsilateral upper limb pain after 1 month (P = 0.000), 2 months after surgery (P = 0.005), 6 months after operation (P = 0.006). The complete remission rate of upper limb pain at 6 months after operation was P = 0.000, the difference was statistically significant. Conclusions: The modified radical mastectomy of intercostobrachial nerve in axillary lymph node dissection of stage Ⅰ and Ⅱ breast cancer does not increase the difficulty of operation, reduces the incidence of skin sensation and pain in the affected upper arm, and improves the postoperative outcome The quality of life, has a certain clinical value.