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目的探讨在乳腺癌改良根治术中保留肋间臂神经的临床应用价值。方法选择2004年7月—2009年7月在华北理工大学附属医院和廊坊市人民医院行乳腺癌改良根治术的患者共有120例,将其分为观察组和对照组。观察组60例,均在术中保留肋间臂神经;对照组60例,均在术中切除肋间臂神经。观察二组患者临床资料、术中情况、术后并发症、局部复发和远处转移、远期生存率。结果二组患者术中情况在手术时间、术中出血量、淋巴结清扫数目方面,差异均无统计学意义(P>0.05);术后1周、6个月感觉障碍在疼痛、烧灼、麻木、感觉减退或消失方面,差异均具有统计学意义(χ2值分别为10.87,8.08,8.68,9.31,P<0.05;χ2值分别为11.70,9.00,18.22,9.40,P<0.05);术后5年出现局部复发、远处转移及生存率,差异无统计学意义(χ2值分别为0.10,0.44,1.29,P值均>0.05)。结论乳腺癌改良根治术中保留肋间臂神经,能够明显降低患侧上肢的感觉障碍,不明显延长手术时间,也不会增加局部复发和远处转移。术中保留肋间臂神经可改善患者术后生活质量,具有一定的临床应用价值。
Objective To investigate the clinical value of preserving intercostobrachial nerve in radical mastectomy of breast cancer. Methods A total of 120 patients underwent modified radical mastectomy at North China University of Technology Affiliated Hospital and Langfang People’s Hospital from July 2004 to July 2009 were divided into observation group and control group. The observation group of 60 cases, intraoperative preservation of intercostobrachial nerve; control group of 60 patients were undergone resection of the intercostobrachial nerve. The clinical data, intraoperative status, postoperative complications, local recurrence and distant metastasis, long-term survival rate were observed. Results There was no significant difference in the operation time, blood loss and the number of lymphadenectas between the two groups (P> 0.05). The sensory disturbances of pain, burning, numbness, (P <0.05); χ2 values were 11.70,9.00,18.22,9.40, P <0.05, respectively); after 5 years (P <0.05), the difference was statistically significant (χ2 values were 10.87,8.08,8.68,9.31, There were local recurrence, distant metastasis and survival rate, the difference was not statistically significant (χ2 values were 0.10,0.44,1.29, P values were> 0.05). CONCLUSIONS: The preservation of the intercostobrachial nerve during radical mastectomy of breast cancer can significantly reduce the sensory disturbance of the affected upper limbs, prolong the operation time, and not increase the local recurrence and distant metastasis. Intraoperative preservation of intercostobrachial nerve can improve postoperative quality of life of patients with a certain clinical value.