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醫(yī)學免費論文:保留肋間臂神經(jīng)在乳腺癌改良根治術中的應用及臨床意義
【摘要】 目的 探討保留肋間臂神經(jīng)(ICBN)在乳腺癌腋淋巴結清掃術中的可行性及臨床應用價值。方法 76例乳腺癌患者在行腋淋巴結清掃時，游離并保留腋下脂肪組織中的ICBN，術后測試患側上臂內(nèi)后側的感覺功能變化。結果 術后上臂內(nèi)后側感覺異常發(fā)生率為5.26%(4/76)，2周后癥狀消失，經(jīng)1～6個月隨訪均未發(fā)生局部復發(fā)。結論 乳腺癌腋淋巴結清掃術中保留ICBN，可明顯減少乳房切除術后疼痛綜合征(PMPS)的發(fā)生率，有利于改善患者術后的生存質(zhì)量，具有一定的臨床應用價值。
【關鍵詞】 乳腺癌; 肋間臂神經(jīng); 腋窩淋巴結清掃
The clinical significance of reserving intercostobrachial nerve during modified radical mastectomy ZHAO Yanfeng,LI Hui,JIANG Guoxu,et al.Department of General Surgery , Huabei Oil Field General Hospital , Renqiu 062552 , China
【Abstract】 Objective To investigate the possibility and clinical significance of reserving intercostobrachial nerve(ICBN) during the modified radical mastectomy. Methods 76 cases of breast carcinoma were treated by the modified radical mastectomy. The intereostobrachial nerves were saved in lymph node dissection. After operation, the sensation of ill side’s upper arm was observed. Results 5.26% patients had abnormal sensation on the skin of medial upper arms after operation, and the symptoms disappeared 2 weeks later. No recurrence was found during 1 to 6month. followup.Conclusion Reserving ICBN in axillary lymph node dissection for the patients with breast cancer, which has certain clinical values, can obviously reduce the incidence of pain syndrome and improve the life quality of the patients after operations醫(yī).學全.在.線網(wǎng)站52667788.cn.
【Key words】 Breast carcinoma;Intercostobrachial nerve;Axillary lymph node dissection
目前乳腺癌仍是嚴重威脅女性身心健康的疾病之一。腋窩淋巴結清掃是乳腺癌外科手術治療的重要術式，傳統(tǒng)手術不保留肋間臂神經(jīng)(intercostobrachial nerve, ICBN)，常導致患者術后出現(xiàn)臂腋部疼痛及感覺異常，明顯降低生活質(zhì)量。我科自2004年2月以來，對76例乳腺癌患者行腋窩淋巴結清掃同時保留ICBN，取得了滿意的臨床效果。
1 資料與方法
確診乳腺癌患者76例，年齡28～71歲，平均43歲。術前腋窩彩超檢查確定有或無淋巴結腫大及腫大淋巴結部位，術中均行快速冰凍切片檢查確認為乳腺癌。均采用Auchincloss術。術中可采用經(jīng)胸小肌后方途徑、經(jīng)腋靜脈下方兩種途徑尋找ICBN，常用第二種方式。自腋靜脈前方切開腋筋膜懸韌帶，于腋靜脈下方將脂肪淋巴組織向下剝離，暴露胸背及胸長神經(jīng)后，以手指向下剝離脂肪囊后一般可觸及條索樣物，即找到ICBN。暴露后近端可至其起始部，遠端達腋窩處皮下。尋找及游離ICBN全程耗時5～10 min。
2 結果
