Application Value of Ultrasound Knife in Modified Radical Mastectomy of Breast Cancer for Remaining Pectoral Nerve and Intercostobrachial Nerve_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 DUGuo-cheng ¹ , ZHANGMao-chun ² , LIUZhen-zhen ¹ , ZHUKe-peng ¹ , YIWen ¹ , ZHUDong-mei ³

1. Department of General Surgery, Nanchong Central Hospital, Nanchong 637000, Sichuan Province, China;
2. Department of Ultrasound, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China;
3. Department of Ultrasound, Nanchong Central Hospital, Nanchong 637000, Sichuan Province, China;

Corresponding author：

DUGuo-cheng, Email: dgc750504@163.com

Keywords：

Ultrasound knife; Breast cancer; Modified radical mastectomy; Pectoral nerve; Intercostobrachial nerve

DOI：

10.7507/1007-9424.20150059

Video：

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Objective To investigate the value of ultrasound knife in modified radical mastectomy for remaining pectoral nerve and intercostobrachial nerve. Methods One hundred and sixty patients with breast cancer were divided into ultrasound knife group and electroscalpe group and then performed modified radical mastectomy with pectoral nerve and intercostobrachial nerve remainning. the pectoralis major thickness and paresthesia of skin of inner upper arm and axillary fossa were detected on the different time after operation. Results ①The age, body mass index, and mean opera-tion time had no significant differences between these two groups (P > 0.05).②On 6 months after operation, the thickness of bilateral pectoralis major was not significantly different in the ultrasound knife group (P > 0.05), which of injuried pectoralis major was significantly thinner than that of uninjuried pectoralis major in the electroscalpe group (P < 0.05).③The rates of paresthesia of skin on postoperative 3 months and 6 months in the ultrasound knife group were signifi-cantly lower than those in the electroscalpe group (P < 0.05). Conclusion Compared with monopolar electro diathermy, the use of ultrasonic harmonic scalpel in modified radical mastectomy could better protect pectoral nerve and intercosto-brachial nerve, and thus decrease nerve parafunctional rate.

Citation： DUGuo-cheng, ZHANGMao-chun, LIUZhen-zhen, ZHUKe-peng, YIWen, ZHUDong-mei. Application Value of Ultrasound Knife in Modified Radical Mastectomy of Breast Cancer for Remaining Pectoral Nerve and Intercostobrachial Nerve. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(2): 220-223. doi: 10.7507/1007-9424.20150059 Copy

1.	郑莹, 吴春晓, 张敏璐.乳腺癌在中国的流行状况和疾病特征.中国癌症杂志, 2013, 23(8): 561-569.
2.	许红, 毛德强, 王燕.重庆市女性肿瘤发病率及年龄特征分析.重庆医学, 2010, 39(11): 1422-1423, 1447.
3.	吴祥德, 董守义.乳腺疾病诊治.第2版.北京:人民卫生出版社, 2009: 176-179.
4.	Loukas M, Louis RG, Fitzsimmons J, et al. The surgical anatomy of the ansa pectoralis. Clin Anat, 2006, 19(8): 685-693.
5.	吴诚义, 姚榛祥, 吴凯南, 等.乳腺癌腋清扫术中保留肋间臂神经的方法和意义.外科理论与实践, 2001, 6(4): 210-212.
6.	Ivanović N, Granić M, Randelović T, et al. Functional effects of preserving the intercostobrachial nerve and the lateral thoracic vein during axillary dissection in breast cancer conservative surgery. Vojnosanit Pregl, 2007, 64(3): 195-198.
7.	支珍, 刘小敏, 孙利国, 等.乳腺癌根治术保留肋间臂神经临床价值分析.中国实用外科杂志, 2009, 2(2): 160-161.
8.	中华人民共和国卫生部.乳腺癌诊疗规范(2011年版).卫办医政发〔2011〕78号.
9.	霞富士雄.技巧与误区:乳腺外科要点与盲点.沈阳:辽宁科学技术出版社, 2005: 5.
10.	郭仁宣.乳腺外科学.沈阳:辽宁科学技术出版社, 2003: 7.
11.	Kanehira E, Omura K, Kinoshita T, et al. How secure are the arteries occluded by a newly developed ultrasonically activated device? Surg Endosc, 1999, 13(4): 340-342.
12.	Kakarala K, Faquin WC, Deschler DG. A comparison of histopathologic margin assessment after steel scalpel, monopolar electrosurgery, and ultrasonic scalpel glossectomy in a rat model. Laryngoscope, 2010, 120 Suppl 4: S155.
13.	陈洁, 曾荷琳, 吕青, 等.超声刀在乳腺癌Auchincloss改良根治术中应用的随机对照研究.华西医学, 2011, 26(7): 965-967.
14.	肖祥胜, 李峻, 张丽娟, 等.超声刀在乳腺癌改良根治术中的应用.实用医学杂志, 2010, 26(23): 4365-4366.
15.	韩中保, 周羽, 韩扣兰.乳腺癌根治术保留肋间臂神经对患者术后生存质量的影响.中国临床解剖学杂志, 2011, 29(5): 591-593, 596.
16.	陆深泉, 刘涛.乳腺癌改良根治术中保留肋间臂神经疗效的近期观察.中国普外基础与临床杂志, 2012, 19(9): 995-997.
17.	吴瑞正, 齐晓伟, 张帆.保留中、下胸肌神经的Patey手术41例分析.中华乳腺病杂志:电子版, 2013, 7(4): 12-14.
18.	Macdonald L, Bruce J, Scott NW, et al. Long-term follow-up of breast cancer survivors with post-mastectomy pain syndrome. Br J Cancer, 2005, 92(2): 225-230.
19.	辛玲, 冯艺.乳腺癌术后疼痛综合征的前瞻性研究及相关因素分析.中国疼痛医学杂志, 2013, 19(3): 159-163.
20.	Andersen KG, Aasvang EK, Kroman N, et al. Intercostobrachial nerve handling and pain after axillary lymph node dissection for breast cancer. Acta Anaesthesiol Scand, 2014, 58(10): 1240-1248.
21.	Freeman SR, Washington SJ, Pritchard T, et al. Long term results of a randomised prospective study of preservation of the intercostobrachial nerve. Eur J Surg Oncol, 2003, 29(3): 213-215.

1. 郑莹, 吴春晓, 张敏璐.乳腺癌在中国的流行状况和疾病特征.中国癌症杂志, 2013, 23(8): 561-569.
2. 许红, 毛德强, 王燕.重庆市女性肿瘤发病率及年龄特征分析.重庆医学, 2010, 39(11): 1422-1423, 1447.
3. 吴祥德, 董守义.乳腺疾病诊治.第2版.北京:人民卫生出版社, 2009: 176-179.
4. Loukas M, Louis RG, Fitzsimmons J, et al. The surgical anatomy of the ansa pectoralis. Clin Anat, 2006, 19(8): 685-693.
5. 吴诚义, 姚榛祥, 吴凯南, 等.乳腺癌腋清扫术中保留肋间臂神经的方法和意义.外科理论与实践, 2001, 6(4): 210-212.
6. Ivanović N, Granić M, Randelović T, et al. Functional effects of preserving the intercostobrachial nerve and the lateral thoracic vein during axillary dissection in breast cancer conservative surgery. Vojnosanit Pregl, 2007, 64(3): 195-198.
7. 支珍, 刘小敏, 孙利国, 等.乳腺癌根治术保留肋间臂神经临床价值分析.中国实用外科杂志, 2009, 2(2): 160-161.
8. 中华人民共和国卫生部.乳腺癌诊疗规范(2011年版).卫办医政发〔2011〕78号.
9. 霞富士雄.技巧与误区:乳腺外科要点与盲点.沈阳:辽宁科学技术出版社, 2005: 5.
10. 郭仁宣.乳腺外科学.沈阳:辽宁科学技术出版社, 2003: 7.
11. Kanehira E, Omura K, Kinoshita T, et al. How secure are the arteries occluded by a newly developed ultrasonically activated device? Surg Endosc, 1999, 13(4): 340-342.
12. Kakarala K, Faquin WC, Deschler DG. A comparison of histopathologic margin assessment after steel scalpel, monopolar electrosurgery, and ultrasonic scalpel glossectomy in a rat model. Laryngoscope, 2010, 120 Suppl 4: S155.
13. 陈洁, 曾荷琳, 吕青, 等.超声刀在乳腺癌Auchincloss改良根治术中应用的随机对照研究.华西医学, 2011, 26(7): 965-967.
14. 肖祥胜, 李峻, 张丽娟, 等.超声刀在乳腺癌改良根治术中的应用.实用医学杂志, 2010, 26(23): 4365-4366.
15. 韩中保, 周羽, 韩扣兰.乳腺癌根治术保留肋间臂神经对患者术后生存质量的影响.中国临床解剖学杂志, 2011, 29(5): 591-593, 596.
16. 陆深泉, 刘涛.乳腺癌改良根治术中保留肋间臂神经疗效的近期观察.中国普外基础与临床杂志, 2012, 19(9): 995-997.
17. 吴瑞正, 齐晓伟, 张帆.保留中、下胸肌神经的Patey手术41例分析.中华乳腺病杂志:电子版, 2013, 7(4): 12-14.
18. Macdonald L, Bruce J, Scott NW, et al. Long-term follow-up of breast cancer survivors with post-mastectomy pain syndrome. Br J Cancer, 2005, 92(2): 225-230.
19. 辛玲, 冯艺.乳腺癌术后疼痛综合征的前瞻性研究及相关因素分析.中国疼痛医学杂志, 2013, 19(3): 159-163.
20. Andersen KG, Aasvang EK, Kroman N, et al. Intercostobrachial nerve handling and pain after axillary lymph node dissection for breast cancer. Acta Anaesthesiol Scand, 2014, 58(10): 1240-1248.
21. Freeman SR, Washington SJ, Pritchard T, et al. Long term results of a randomised prospective study of preservation of the intercostobrachial nerve. Eur J Surg Oncol, 2003, 29(3): 213-215.

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Application Value of Ultrasound Knife in Modified Radical Mastectomy of Breast Cancer for Remaining Pectoral Nerve and Intercostobrachial Nerve

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