目的 探讨乳腺癌改良根治术中保留肋间臂神经（ICBN）的临床效果。方法 笔者所在医院2005年3月至2009年3月期间行乳腺癌改良根治术54例，其中保留ICBN 39例，未能保留者15例，术后严密追踪观察。结果 保留ICBN和未能保留ICBN患者术后1个月皮肤感觉异常者分别为5例（12.8%）和13例（86.7%），两者差异有统计学意义（P＜0.01）；保留ICBN感觉异常者均在术后2～3个月内恢复正常，未保留ICBN感觉异常者3个月后症状稍有改善，有7例6个月后仍未恢复。全部病例均获随访，随访时间6～36个月，平均22个月，无复发。结论 保留ICBN能减少乳腺癌患者术后上肢感觉障碍的发生，提高其生活质量。
【摘要】目的探讨乳腺癌仿根治术中保留肋间臂神经（ICBN）的临床意义。方法将184例Ⅰ～Ⅲ期乳腺癌患者随机均分为两组，实验组术中保留ICBN； 对照组术中均切除ICBN。并对两组患者术后进行随访观察。结果两组乳腺癌切除均行常规仿根治术，手术过程顺利，平均手术时间实验组为（140±10） min，对照组为（130±10） min，实验组92例术中有80例成功保留ICBN，且患侧上肢感觉障碍发生率为6.25%（5/80），对照组发生率为54.3%（50/92），两组比较差异有显著性意义（χ2=45.51，P＜0.01），经术后3个月～3年随访，上肢感觉障碍实验组5例中有2例1年后好转； 对照组50例中1年后好转6例，两组肿瘤均无局部复发。结论在乳腺癌仿根治术中保留ICBN可有效地防止患侧上肢感觉障碍的发生。
ObjectiveTo investigate the value of ultrasound knife in modified radical mastectomy for remaining pectoral nerve and intercostobrachial nerve. MethodsOne 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. Results①The 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). ConclusionCompared 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.