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目的探讨乳腺癌改良根治术中保留肋间臂神经(ICBN)的可行性。方法回顾性分析2004年6月至2013年6月华北理工大学附属医院肿瘤外科收治的429例行乳腺癌改良根治术患者的临床资料,其中保留肋间臂神经组112例(ICBN保留组),切除肋间臂神经组317例(ICBN切除组)。采用t检验比较两组患者手术时间、出血量和淋巴结清扫数目的差异,并用χ2检验比较两组患者术后1个月和6个月时感觉障碍发生率的差异,以及局部复发和远处转移发生率的差异。结果两组患者的手术时间、出血量及淋巴结清扫数目相近[ICBN保留组∶ICBN切除组:(96.7±25.8)min比(99.4±23.9)min,t=-1.00,P=0.320;(121.3±29.0)ml比(126.8±30.9)ml,t=-1.65,P=0.099;(19.6±7.5)枚比(18.9±7.1)枚,t=0.95,P=0.342]。术后1个月和6个月时,ICBN保留组患者感觉障碍发生率明显低于ICBN切除组[42.9%(48/112)比83.9%(266/317),χ2=71.09,P<0.001;18.8%(21/112)比63.4%(201/317),χ2=66.10,P<0.001]。中位随访36个月(6~36个月)时,两组患者的局部复发和远处转移发生率均相似[ICBN保留组∶ICBN切除组:16.1%(18/112)比19.2%(61/317),χ2=0.55,P=0.457;11.6%(13/112)比15.1%(48/317),χ2=0.85,P=0.357]。结论乳腺癌改良根治术中保留肋间臂神经是可行的。
Objective To investigate the feasibility of preserving intercostobrachial nerve (ICBN) in radical mastectomy of breast cancer. Methods The clinical data of 429 patients undergoing modified radical mastectomy admitted from June 2004 to June 2013 in the Department of Oncology, Affiliated Hospital of North China Polytechnic University were retrospectively analyzed. Among them, 112 (ICBN reserved group) 317 cases of intercostobrachial nerve resection (ICBN resection group). The difference of operative time, blood loss and number of lymph node dissection between the two groups were compared by t-test. The differences of sensory dysfunction between 1 month and 6 months after operation were compared by χ2 test, and the local recurrence and distant metastasis The difference in incidence. Results The operation time, the amount of bleeding and the number of lymph node dissection in both groups were similar [ICBN group: (96.7 ± 25.8) min vs (99.4 ± 23.9) min, t = -1.00, P = 29.0) ml (126.8 ± 30.9) ml, t = -1.65, P = 0.099; (19.6 ± 7.5), 18.9 ± 7.1, t = 0.95, P = 0.342]. At 1 month and 6 months after operation, the incidence of sensory disturbances was significantly lower in ICBN-preserved patients than in ICBN-resected patients (42.9% (48/112) vs 83.9% (266/317), χ2 = 71.09, P <0.001) 18.8% (21/112) vs 63.4% (201/317), χ2 = 66.10, P <0.001]. At a median follow-up of 36 months (range, 6 to 36 months), the incidence of local recurrence and distant metastases was similar in both groups [ICBN retention group: ICBN resection group: 16.1% (18/112) vs. 19.2% /317),χ2=0.55,P=0.457;11.6%(13/112) than 15.1% (48/317), χ2 = 0.85, P = 0.357]. Conclusion It is feasible to keep the intercostobrachial nerve in the modified radical mastectomy of breast cancer.