刘欣金

【摘要】 目的：探讨保留肋间臂神经（intercostobrachial nerve，ICBN）与胸前神经（anterior thoracic nerve，ATN）的乳腺癌改良根治术对患者上肢功能、感觉及疼痛的影响。方法：选取2017年6月-2020年6月于本院行乳腺癌改良根治术的80例乳腺癌患者的临床资料进行回顾性分析，根据术中是否保留ICBN与ATN将其分为研究组与对照组，每组40例。研究组术中保留ICBN与ATN，对照组则不保留。比较两组淋巴结清扫数目、住院时间、手术时间及术中出血量;比较两组术前与术后3个月上肢前屈、后伸、外展功能;比较两组术后1个月上肢知觉减弱、疼痛、灼痛、麻木等感觉障碍发生情況;比较两组术后1、3个月静息及运动状态下视觉模拟评分法（visual analogue score，VAS）评分。结果：两组手术时间、淋巴结清扫数目、术中出血量及住院时间比较，差异均无统计学意义（P>0.05）。两组术后3个月上肢前屈、后伸及外展功能均优于术前，且研究组均优于对照组（P<0.05）。研究组术后1个月上肢知觉减弱、疼痛、灼痛及麻木发生率均低于对照组（P<0.05）。研究组术后1、3个月静息及运动状态下VAS评分均低于对照组（P<0.05）。结论：保留ATN与ICBN的乳腺癌改良根治术可以有效减少患者上肢知觉减弱、疼痛、灼痛、麻木的发生，并且对上肢前屈、后伸、外展功能的恢复具有积极意义，疗效显著，应予推广。

【关键词】 乳腺癌 改良根治术 胸前神经 肋间臂神经 上肢功能

Effect of Modified Radical Mastectomy with Intercostobrachial Nerve and Anterior Thoracic Nerve Retained on Upper Limb Function， Sensation and Pain Degree/LIU Xinjin. //Medical Innovation of China， 2021， 18（13）： 0-060

[Abstract] Objective： To investigate the effects of modified radical mastectomy with intercostobrachial nerve （ICBN） and anterior thoracic nerve （ATN） retained on upper limb function， sensation and pain of breast cancer patients. Method： The clinical data of 80 patients with breast cancer who underwent modified radical mastectomy of breast cancer in our hospital from June 2017 to June 2020 were retrospectively analyzed， and they were divided into study group and control group according to whether ICBN and ATN were retained during surgery， with 40 cases in each group. In the study group， ICBN and ATN were retained intraoperatively， but not in the control group. The number of dissected lymph nodes， length of hospital stay， operative time and intraoperative blood loss were compared between the two groups. The flexion， extension and abduction of the upper limbs were compared between the two groups before and 3 months after surgery. The incidence of decreased sensation， pain， burning pain， numbness and other sensory disorders of upper extremity were compared between the two groups 1 month after surgery. Visual analogue score （VAS） scores at rest and during exercise were compared between the two groups 1 and 3 months after surgery. Result： There were no significant differences in operative time， number of dissected lymph nodes， intraoperative blood loss and length of hospital stay between the two groups （P>0.05）. 3 months after surgery， the flexion， extension and abduction functions of the upper limbs in both groups were better than those before operation， and those in the study group were better than those in the control group （P<0.05）. The incidences of decreased sensation， pain， burning pain and numbness in the upper extremity of the study group were lower than those of the control group at 1 month after surgery （P<0.05）. VAS scores in the study group were lower than those in the control group at resting and exercise state 1 and 3 months after surgery （P<0.05）. Conclusion： The modified radical mastectomy of breast cancer with ATN and ICBN retained can effectively reduce the occurrence of reduced sensation， pain， burning pain and numbness of the patients upper limbs， and has positive significance for the recovery of the functions of flexion， extension and abduction of the upper limbs. The curative effect is significant and should be promoted.

[Key words] Breast cancer Modified radical mastectomy Anterior thoracic nerve Intercostobrachial nerve Upper limb function

First-authors address： Dongguan Kanghua Hospital， Dongguan 523000， China

doi：10.3969/j.issn.1674-4985.2021.13.014

乳腺上皮组织中形成的恶性肿瘤称为乳腺癌，在女性中，发病率很高，是女性患恶性肿瘤的首位[1]。目前，大多采用外科手术进行乳腺癌根治治疗，而随着临床对乳腺癌生物学特征进一步深入研究，发现并证实了乳腺癌属于全身性的肿瘤疾病[2]。因此，在治疗理念上要发生转变，从传统根治治疗与扩大性根治治疗，慢慢演变为个性化、功能保护、微创化以及精准化的治疗方向[3]。根据相关研究报道，乳腺癌改良根治术逐步地成为当前乳腺癌治疗的标准术式，且治疗效果已有取代乳腺癌传统根治术的趋势。乳腺……