乳腺癌手術(shù)中保留胸前神經(jīng)和肋間臂神經(jīng)的臨床效果觀察

王西躍+張蓉+鄧丁梅

[摘要] 目的 分析保留胸前神經(jīng)和肋間臂神經(jīng)的乳腺癌手術(shù)臨床效果。 方法 選取我院2013年1月～2014年1月收治入院的擇期手術(shù)的乳腺癌患者60例作為研究對象，并按不同的治療方式分為兩組，對照組30例患者采用傳統(tǒng)乳腺癌手術(shù)治療，觀察組30例患者采用保留肋間臂神經(jīng)和胸前神經(jīng)的乳腺癌手術(shù)，對患者的不良反應(yīng)、并發(fā)癥、腫瘤復(fù)發(fā)及轉(zhuǎn)移率進(jìn)行觀察及比較。 結(jié)果 觀察組平均手術(shù)時(shí)間及清除淋巴結(jié)數(shù)目比較差異無統(tǒng)計(jì)學(xué)意義（P>0.05）；觀察組生活質(zhì)量情況要顯著比對照組好，各項(xiàng)基本評分以及總分都要明顯高于對照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；觀察組患者復(fù)發(fā)、并發(fā)癥的發(fā)生率顯著低于對照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。 結(jié)論 保留肋間臂神經(jīng)和胸前神經(jīng)的乳腺癌手術(shù)能夠顯著減少患者胸肌萎縮，腋窩疼痛、上臂麻木感、皮膚感覺疼痛或障礙等不良反應(yīng)，并且可顯著降低術(shù)后轉(zhuǎn)移率和復(fù)發(fā)率，對提高患者的生活質(zhì)量意義重大，值得臨床推廣。

[關(guān)鍵詞] 胸前神經(jīng)；肋間臂神經(jīng)；乳腺癌

[中圖分類號] R737.9 [文獻(xiàn)標(biāo)識碼] A [文章編號] 2095-0616（2017）06-132-03

[Abstract] Objective To analyze the clinical effect of breast cancer with thoracic nerve and intercostal nerve. Methods 60 patients with breast cancer underwent elective surgery in our hospital from January 2013 to January 2014 were selected as the subjects. According to the different treatment methods，they were divided into two groups.30 patients in the control group were treated with traditional breast cancer treatment，30 patients in observation group were treated with intercostal nerve and thoracic nerve retention of breast cancer surgery.The patients adverse reactions and complications，tumor recurrence and metastasis rate were observed and compared. Results There was no significant difference in the average operative time and the number of lymph nodes removed in the observation group（P>0.05）.The quality of life in the observation group was significantly better than that in the control group.The basic scores and total scores were significantly higher than those in the control group（P<0.05）.The incidence of recurrence and complication in the observation group were significantly lower than those in the control group（P<0.05）. Conclusion Retention of intercostal nerve and thoracic nerve in breast cancer surgery can significantly reduce adverse events such as chest muscle atrophy，axillary pain，upper arm numbness，skin sensory pain or disorder，and significantly reduce postoperative metastasis and recurrence rates.It has great significance in improving the quality of life of patients.It is worthy of clinical promotion.

[Key words] Chest nerve；Intercostal nerve；Breast cancer

乳腺癌是一種較為常見的惡性腫瘤疾病，其發(fā)病率居高不下，且越來越趨于年輕化。據(jù)有關(guān)部門的統(tǒng)計(jì)發(fā)現(xiàn)，乳腺癌在女性新發(fā)惡性腫瘤中的比例達(dá)到了30%[1]。因此，研究乳腺癌的最佳治療方式是非常有必要的。目前，乳腺癌的主要治療方式是通過手術(shù)治療，正確選擇手術(shù)方式可以最大程度改善患者的預(yù)后[2]。傳統(tǒng)的手術(shù)方法將患者胸前神經(jīng)以及肋間臂神經(jīng)進(jìn)行切除，導(dǎo)致患者出現(xiàn)了胸肌萎縮、腋窩疼痛及上臂麻木等癥狀[3]。本研究通過對我院收治的乳腺癌手術(shù)中保留胸前神經(jīng)和肋間臂神經(jīng)的乳腺癌患者30例進(jìn)行效果分析，旨在探討出最有效的治療方法，現(xiàn)報(bào)道如下。

1 資料與方法

1.1 一般資料

選取我院2013年1月～2014年1月收治入院的擇期手術(shù)的乳腺癌患者60例作為研究對象，全部為女性。按治療方式的不同分為兩組，對照組30例患者采用傳統(tǒng)乳腺癌手術(shù)治療，觀察組30例患者采用保留肋間臂神經(jīng)和胸前神經(jīng)的乳腺癌手術(shù)，觀察組患者中年齡25.4～67.9歲，平均（41.4±4.6）歲；腫瘤部位：左側(cè)為17例，右側(cè)為13例；根據(jù)國癌癥聯(lián)合委員會(huì)（AJCC）癌癥分期手冊（第7版）的乳腺癌分期標(biāo)準(zhǔn)：8例為I期，10例為II期，8例為III期，4例為IV期。按病理類型可分為侵潤性小葉癌患者5例，侵潤性導(dǎo)管癌患者19例，黏液腺癌患者6例；對照組患者中年齡25～63歲，平均（40.12±5.83）歲，腫瘤部位：左側(cè)為18例，右側(cè)為12例；根據(jù)國癌癥聯(lián)合委員會(huì)（AJCC）癌癥分期手冊（第7版）的乳腺癌分期標(biāo)準(zhǔn)：7例為I期，11例為II期，7例為III期，5例為IV期。按病理類型可分為侵潤性小葉癌患者4例，侵潤性導(dǎo)管癌患者21例，黏液腺癌患者5例；兩組患者年齡、臨床分期、病理類型、病變部位等內(nèi)容比較差異無統(tǒng)計(jì)學(xué)意義（P>0.05），具有可比性。