中国中西医结合外科杂志
中國中西醫結閤外科雜誌
중국중서의결합외과잡지
CHINESE JOURNAL OF SURGERY OF INTEGRATED TRADITIONAL AND WESTERN MEDICINE
2014年
1期
38-42
,共5页
乳腺癌%乳腺癌改良根治术%肋间臂神经%Meta分析
乳腺癌%乳腺癌改良根治術%肋間臂神經%Meta分析
유선암%유선암개량근치술%륵간비신경%Meta분석
Breast cancer%modified radical mastectomy%intercostal nerve%meta-analysis
目的：探讨保留肋间臂神经与切除肋间臂神经在乳腺癌改良根治术中的临床意义，为制定临床合理的个体化手术方案提供证据。方法：制定原始文献的纳入标准、排除标准及检索策略，搜索关于保留肋间臂神经在乳腺癌改良根治术中的价值和意义方面的临床随机对照试验。检索日期由2000年1月-2012年2月。按cochrane系统评价方法，评价所纳入研究的文献质量，并提取有效数据后采用RevMan5.0软件进行Meta分析。结果纳入12项研究，共计1146例患者。结果：保留肋间神经可以明显减轻患者上臂内侧感觉功能（随访1个月，3个月，12个月OR1=0.15,95%CI：0.10~0.21；OR3=0.06,95%CI：0.03~0.10；OR12=0.07,95%CI：0.03~0.16））,保留肋间臂神经手术时间较切除肋间臂神经在乳腺癌改良根治所用的时间略延长（MD=6.75,95%CI：3.88~9.26）；随访1~3年乳腺癌局部复发率两种术式术中出血量、清除淋巴结数、术后肩关节运动障碍及皮下积液切除ICBN与保留ICBN均没有明显的差异。结论：保留肋间臂神经可以明显减轻乳腺癌改良根治术后患侧上臂内侧感觉功能障碍、延长手术时间但对乳腺癌复发率没有明显影响。
目的：探討保留肋間臂神經與切除肋間臂神經在乳腺癌改良根治術中的臨床意義，為製定臨床閤理的箇體化手術方案提供證據。方法：製定原始文獻的納入標準、排除標準及檢索策略，搜索關于保留肋間臂神經在乳腺癌改良根治術中的價值和意義方麵的臨床隨機對照試驗。檢索日期由2000年1月-2012年2月。按cochrane繫統評價方法，評價所納入研究的文獻質量，併提取有效數據後採用RevMan5.0軟件進行Meta分析。結果納入12項研究，共計1146例患者。結果：保留肋間神經可以明顯減輕患者上臂內側感覺功能（隨訪1箇月，3箇月，12箇月OR1=0.15,95%CI：0.10~0.21；OR3=0.06,95%CI：0.03~0.10；OR12=0.07,95%CI：0.03~0.16））,保留肋間臂神經手術時間較切除肋間臂神經在乳腺癌改良根治所用的時間略延長（MD=6.75,95%CI：3.88~9.26）；隨訪1~3年乳腺癌跼部複髮率兩種術式術中齣血量、清除淋巴結數、術後肩關節運動障礙及皮下積液切除ICBN與保留ICBN均沒有明顯的差異。結論：保留肋間臂神經可以明顯減輕乳腺癌改良根治術後患側上臂內側感覺功能障礙、延長手術時間但對乳腺癌複髮率沒有明顯影響。
목적：탐토보류륵간비신경여절제륵간비신경재유선암개량근치술중적림상의의，위제정림상합리적개체화수술방안제공증거。방법：제정원시문헌적납입표준、배제표준급검색책략，수색관우보류륵간비신경재유선암개량근치술중적개치화의의방면적림상수궤대조시험。검색일기유2000년1월-2012년2월。안cochrane계통평개방법，평개소납입연구적문헌질량，병제취유효수거후채용RevMan5.0연건진행Meta분석。결과납입12항연구，공계1146례환자。결과：보류륵간신경가이명현감경환자상비내측감각공능（수방1개월，3개월，12개월OR1=0.15,95%CI：0.10~0.21；OR3=0.06,95%CI：0.03~0.10；OR12=0.07,95%CI：0.03~0.16））,보류륵간비신경수술시간교절제륵간비신경재유선암개량근치소용적시간략연장（MD=6.75,95%CI：3.88~9.26）；수방1~3년유선암국부복발솔량충술식술중출혈량、청제림파결수、술후견관절운동장애급피하적액절제ICBN여보류ICBN균몰유명현적차이。결론：보류륵간비신경가이명현감경유선암개량근치술후환측상비내측감각공능장애、연장수술시간단대유선암복발솔몰유명현영향。
Objective To explore the clinical significance of difference between reserved inter-costobrachi-al nerve and resected inter-costobrachial nerve in modified radical mastectomy of breast cancer. Methods The results of 12 studies including 1146 patients were used to search for the clinical value and significance of the radical mastectomy of breast cancer for randomized controlled trails by using Cochrane systematic review method to evaluate the quality of searched articles, and RevMan5.0 software for Meta-analysis. Results The retention of inter costobrachial nerve significantly reduced the medial sensory function of upper arm of the pa-tient (follow-up one month, three months, 12 months OR1=0.15,95% CI: 0.10-0.21; OR3=0.06,95% CI:0.03-0.10; OR12=0.07,95% CI: 0.03-0.16)), operation time: time have been extended in retain the inter-costo-brachial nerve than the removal of the intercostal brachial nerve in the modified radical mastectomy of breast cancer (MD=6.75, 95% CI :3.88-9.26);there were no significant differences of local recurrence ratio of those two procedures after 1-3 years follow-up; nor in blood loss during operation, number of lymph nodes removed, postoperative disorders of scapular joint’s movement, and in subcutaneous fluid between removal of intercostobra-chial nerve (ICBN) and reserved ICBN. Conclusion To retain the intercostal brachial nerve can significantly reduce impaired sensory function of upper extremities of the patient who underwent modified radical mastectomy of breast cancer with increased length of surgery time but no significant effect on the recurrence of breast can-cer.
