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医学免费论文:保留肋间臂神经在乳腺癌改良根治术中的应用及临床意义
【摘要】 目的 探讨保留肋间臂神经(ICBN)在乳腺癌腋淋巴结清扫术中的可行性及临床应用价值。方法 76例乳腺癌患者在行腋淋巴结清扫时，游离并保留腋下脂肪组织中的ICBN，术后测试患侧上臂内后侧的感觉功能变化。结果 术后上臂内后侧感觉异常发生率为5.26%(4/76)，2周后症状消失，经1～6个月随访均未发生局部复发。结论 乳腺癌腋淋巴结清扫术中保留ICBN，可明显减少乳房切除术后疼痛综合征(PMPS)的发生率，有利于改善患者术后的生存质量，具有一定的临床应用价值。
【关键词】 乳腺癌; 肋间臂神经; 腋窝淋巴结清扫
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医.学全.在.线网站www.lindalemus.com.
【Key words】 Breast carcinoma;Intercostobrachial nerve;Axillary lymph node dissection
目前乳腺癌仍是严重威胁女性身心健康的疾病之一。腋窝淋巴结清扫是乳腺癌外科手术治疗的重要术式，传统手术不保留肋间臂神经(intercostobrachial nerve, ICBN)，常导致患者术后出现臂腋部疼痛及感觉异常，明显降低生活质量。我科自2004年2月以来，对76例乳腺癌患者行腋窝淋巴结清扫同时保留ICBN，取得了满意的临床效果。
1 资料与方法
确诊乳腺癌患者76例，年龄28～71岁，平均43岁。术前腋窝彩超检查确定有或无淋巴结肿大及肿大淋巴结部位，术中均行快速冰冻切片检查确认为乳腺癌。均采用Auchincloss术。术中可采用经胸小肌后方途径、经腋静脉下方两种途径寻找ICBN，常用第二种方式。自腋静脉前方切开腋筋膜悬韧带，于腋静脉下方将脂肪淋巴组织向下剥离，暴露胸背及胸长神经后，以手指向下剥离脂肪囊后一般可触及条索样物，即找到ICBN。暴露后近端可至其起始部，远端达腋窝处皮下。寻找及游离ICBN全程耗时5～10 min。
2 结果
