乳腺癌腋窝淋巴结清除中保留肋间臂神经的影响研究.docVIP

乳腺癌腋窝淋巴结清除中保留肋间臂神经的影响研究 候海生1王秋艳2陈少川2 （1河北省秦皇岛军工医院普外科，河北秦皇岛066000 2河北省秦皇岛军工医院重症医学科，河北秦皇岛066000） 摘要：目的：本研究旨在评估乳腺癌腋窝淋巴结清除过程中肋间臂神经保留与手臂疼痛敏感度、手术总时间及直接清除腋窝淋巴结数之间的关系。方法：该研究为前瞻性双盲法的干预实验，实施年份为2007年7月至2010年8月，研究中共招募85位患者。根据肋间臂神经是否保留被分为两组。手术是由同一名医生采用同样的方法实施的。术后评估在术后2天、30天、90天分别进行评估。疼痛敏感度通过专业的调查问卷和神经学检查进行量化评估。该手术方案100%可行，结果：肋间臂神经的保留无论是问卷调查还是神经检查中均显示其可以显著减轻手臂的疼痛敏感度。术后满3月，调查问卷发现肋间臂神经保留患者中61%的人已无疼痛症状，而切除组中仅28.6%（p0.01）；神经检查发现肋间臂神经保留组中53.7%的患者神经检查结果显示正常而在切除组仅16.7%（p0.01）。在对手术总时间的对比中未发现两种手术耗费时间有差异（p=0.76）且两组切除的淋巴结数也无差异(p = 0.59)。且在3年随访中两组均未发现肿瘤复发。结论：该研究表明保留肋间臂神经是可行的，且可减轻疼痛，不会增加手术时间，切除的淋巴结数也不会改变，也不会造成肿瘤复发。 关键词：乳腺癌、腋窝淋巴清除术、肋间臂神经、疼痛敏感度 Impact of the Preservation of theIntercostobrachial Nerve in AxillaryLymphadenectomy due to Breast Cancer Hou Haisheng1, Wang Qiuyan2, Chen Shaochuan2 (1 Department of General Surgery, Qinhuangdao military hospital in Hebei Province, Qinhuangdao Hebei 066000, china,Corresponding author. 2 Department of Critical Care Medicine, Qinhuangdao military hospital in Hebei Province, Qinhuangdao Hebei 066000, china) Abstract: This study aimed to evaluate the relationships betweenpreservationoftheintercostobrachial(ICB)nerveandpainsensitivity of the arm, the total time of the surgery, and thenumber of dissected nodes in patients submitted to axillarylymphadenectomy insurgical treatment of breast cancer. An prospective, randomized, and double blind intervention was performedon 85 patients at the Qinhuangdao military hospital in Hebei ProvincefromJuly2007 to august 2010. The patients according to whether the ICB nerve was preserved ornotwere divided into twogroups. The surgeries were performed by the same surgeons, and the same technique. The postoperative evaluations wereperformed at 2 days, 30 days, and 90 days. The pain sensitivity of the arm wassubjectivelyevaluated with an questionnaireand objectively assessed with a neurologic examination. The outcome presented afeasibility of 100% and preservation of the ICB nerve was relatedto a signi?cant decrease in the pai