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目的探讨乳腺癌保乳手术中保留胸前神经(ATN)和肋间臂神经(ICBN)的方法及意义。方法回顾近5年间乳腺癌行保乳术的382例患者病历资料。保留ATN及ICBN者312例,切断ATN及ICBN者70例。术后随访观察胸大小肌萎缩情况和患侧腋窝、上臂内侧的感觉异常情况。结果保留ATN及ICBN患者患侧腋部及上臂内侧皮肤感觉正常占80.4%(251/312),感觉异常占19.6%(61/312),且多可在2~3个月内恢复;术后3个月胸肌无明显萎缩,外形良好,患肢负重运动良好。切断ATN及ICBN的70例患者仅16例(22.9%)感觉正常,54例(77.1%)有不同程度的感觉异常,主要表现为患侧腋窝、上臂内侧及肩胛下部位的疼痛、麻木、酸胀、蚁行感和烧灼感等;术后3个月患侧胸肌不同程度萎缩及上肢活动障碍、功能减退。结论乳腺癌保乳术中保留ATN及ICBN是可行的,可有效减少患侧腋部及上肢感觉异常和胸肌萎缩的发生率,改善患者术后生活质量。
Objective To investigate the method and significance of preserving the anterior chest nerve (ICN) and chest thoracic nerve (ICBN) in breast conserving surgery. Methods A retrospective review of medical records of 382 patients undergoing breast-conserving surgery during the past 5 years. There were 312 cases with ATN and ICBN reserved and 70 cases with ATN and ICBN severed. Postoperative follow-up observation of chest muscle atrophy and the affected side of the armpit, the upper arm of the inner side of the sensory abnormalities. Results The patients with ATN and ICBN had a normal feeling of 80.4% (251/312) in the ipsilateral axilla and the medial upper arm. The sensory abnormalities accounted for 19.6% (61/312), and were mostly recovered within 2 to 3 months. 3 months no significant atrophy of the pectoral muscles, good shape, limb weight movement well. Seventy of the 70 patients with ATN and ICBN were found to be normal in only 16 patients (22.9%) and 54 (77.1%) with varying degrees of sensory abnormalities. The main manifestations were pain, numbness and soreness in the armpits, medial upper arm and subscapular region , Ants sense and burning sensation, etc .; 3 months after operation ipsilateral pectoral muscle atrophy and upper limb dysfunction, dysfunction. Conclusion Preservation of ATN and ICBN in breast conserving surgery is feasible, which can effectively reduce the incidence of side axillary and upper limb sensory abnormalities and chest muscle atrophy, and improve postoperative quality of life.