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目的探讨乳腺癌保留乳房根治手术(以下简称保乳手术)中腋窝淋巴结清扫时保留肋间臂神经(intercostobraehial nerve,ICBN)的临床意义。方法回顾分析2006年9月至2009年1月开展的46例行保乳手术乳腺癌患者(48个乳房)的临床资料,其中保留ICBN患者26例,未保留ICBN患者22例作为对照进行研究分析,比较两组患者手术中用时、术中出血量、术后患肢感觉变化以及术中清扫淋巴结的数目。结果两组病例术中出血量、清扫淋巴结数目差异无显著性,腋窝淋巴结清扫手术用时、上臂后内侧及腋部皮肤麻木与疼痛感发生率差异具有显著性。结论在0期、Ⅰ期、部分Ⅱa期乳腺癌患者保乳手术中,行腋淋巴结清扫术中保留ICBN是可行的,延长手术时间是可以接受的,不增加出血量,不影响淋巴结清扫,可改善患者术后的感觉障碍(局部麻木与刺痛感),提高生活质量。
Objective To investigate the clinical significance of preserving intercostobraehial nerve (ICBN) during axillary lymph node dissection in breast cancer radical mastectomy (hereinafter referred to as breast conserving surgery). Methods The clinical data of 46 breast conserving breast cancer patients (48 breasts) from September 2006 to January 2009 were retrospectively analyzed. Among them, 26 patients with ICBN retained and 22 patients with unrelated ICBN were studied as a control The operation time, intraoperative blood loss, postoperative limb sensory changes and the number of lymph nodes dissected during operation were compared between the two groups. Results There was no significant difference between the two groups in the amount of hemorrhage and the number of lymph nodes dissected. The incidence of numbness and pain in the medial and axillary skin of the upper arm when the axillary lymph node dissection was performed was significant. Conclusion It is feasible to preserve ICBN during axillary lymph node dissection during the breast-conserving surgery in patients with stage Ⅰ and part Ⅱa breast cancer. It is acceptable to prolong the operation time without increasing the amount of bleeding and affecting the lymph node dissection Improve postoperative sensory disturbance (local numbness and tingling) and improve quality of life.