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目的对乳腺癌腋窝淋巴结清扫术中保留肋间臂神经(ICBN)的临床价值与可行性进行多因素分析。方法随机选择27例Ⅰ、Ⅱ期乳腺癌患者施行完整保留ICBN的乳腺癌腋窝淋巴结清扫术,同时选择22例切除ICBN的患者作为对照。对手术时间、术中清扫和术后复查的淋巴结数目、术后主观感觉与客观神经检查多方面进行比较。结果保留肋间臂神经组与切除组比较,手术时间、术中淋巴结清扫数目、术后2周和6个月B超复查腋淋巴结均无显著性差异,而术后5d(P<0.05)、30d(P<0.05)、3个月(P<0.05)的上臂内侧及腋部皮肤麻木与疼痛感发生率、神经检查阳性率均具有显著性差异。结论在Ⅰ、Ⅱ期乳腺癌的腋淋巴结清扫术中保留肋间臂神经是可行的,不影响清扫效果,不增加局部复发率,可减少患者术后的局部麻木与痛感的发生,具有良好的临床应用价值。
Objective To investigate the clinical value and feasibility of preserving intercostobrachial nerve (ICBN) in axillary lymph node dissection in breast cancer patients by multivariate analysis. Methods A total of 27 breast cancer patients with stage Ⅰ and Ⅱ breast cancer were randomly selected to undergo axillary lymph node dissection of intact ICBN, and 22 patients with ICBN resection were selected as control. The operation time, intraoperative and postoperative review of the number of lymph nodes, postoperative subjective feeling and objective nerve examination in many aspects were compared. Results There was no significant difference in axillary lymph node biopsy between the intercostobrachial nerve group and the resection group at the 5th day after operation (P <0.05), the operation time, the number of lymph nodes dissected, the 2-week and 6-month B- 30d (P <0.05), 3 months (P <0.05) in the medial upper arm and axillary skin numbness and pain incidence, positive rate of nerve tests were significantly different. Conclusion It is feasible to preserve the intercostobrachial nerve in the axillary lymph node dissection of stage Ⅰ and Ⅱ breast cancer without influencing the effect of cleaning and not increasing the local recurrence rate. It can reduce the occurrence of local numbness and pain after operation, and has a good Clinical application value.