摘要目的 探讨乳腺癌手术中保留肋间臂神经的方法及临床意义.方法 回顾性分析47例乳腺癌患者的临床资料.将47例患者随机分为两组,其中保留组25例患者腋窝经过溶脂后,肋间臂神经均予以保留,切除组22例未保留肋间臂神经,记录两组手术时间、术中淋巴结清扫数量及术后患者的预后情况,所有患者术后进行常规患肢功能锻炼,观察术后患者上臂感觉功能情况.结果 术后3周观察患者上臂感觉功能情况,保留组中4例患者出现皮肤麻木,感觉减退,占16.0％;切除组中19例患者出现不同程度的皮肤感觉异常,占86.4％,主要表现为感觉减退、麻木、疼痛及烧灼感,两组比较差异有统计学意义(x2 =20.361,P＜0.05).两组患者在清扫淋巴结数目及手术时间方面比较差异均未见统计学意义(t=0.695、1.720,P均＞0.05).所有患者随访半年后,保留组患者感觉异常症状均恢复,而切除组恢复不明显,仍表现为不同程度的感觉异常,所有患者均未局部复发或远处转移.结论 乳腺癌(特别是Ⅰ～Ⅱ期)手术中经过溶脂技术后,腋窝血管神经更加清晰,保留肋间臂神经更加容易,从而减少了术后患侧上臂感觉异常的发生率,提高了患者生活质量,具有一定的临床应用价值,值得临床推广应用.

abstractsObjective 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 47 cases of breast cancer were analyzed retrospectively.Forty-seven patients were randomly divided into two group with 25 patients in preservation group,whose ICBN were preserved by fat dissolving method,and 22 patients in resection group,whose ICBN were not preserved.The operation times,the number of axillary lymph nodes dissection and postoperative prognosis and upper arm sensory function of patients after operation in both groups were recorded.Results After postoperative 3 weeks,the upper arm sensory function of patients was observed.It showed that 4 cases of sensory numbness or loss occurred in preservation group(16.0％),19 cases of sensory abnormality occurred in resection group(86.4％),mainly as sensory loss,numbness,pain or burning sensation,there was significant difference between the two groups(x2 =20.361,P ＜ 0.05).The number of lymph nodes dissection and operation times between the two groups had no statistically significant difference (t =0.695 and 1.720,P ＞ 0.05).All patients were followed up for half a year,patients with paresthesia symptoms in preservation group recovered,and recovery in resection group was not obvious,it still showed paresthesia in varying degrees.During the follow-up,no local recurrence or distant metastasis was found in both groups.Conclusions Axillary nerve is clearer and preservation of ICBN is easier in breast cancer operation(especially in stage Ⅰ-Ⅱ) by fat dissolving method,thus it may reduce the incidence of postoperative paresthesia and improve the quality of life of patients.It is worthy of clinical application.