国际外科学杂志
國際外科學雜誌
국제외과학잡지
INTERNATIONAL JOURNAL OF SURGERY
2014年
7期
466-469
,共4页
乳腺肿瘤%疼痛%前瞻性研究%淋巴结切除术
乳腺腫瘤%疼痛%前瞻性研究%淋巴結切除術
유선종류%동통%전첨성연구%림파결절제술
Breast neoplasms%Pain%Prospective studies%Lymph node excision
目的 评估乳腺癌腋窝淋巴结清除过程中肋间臂神经保留与手臂疼痛敏感度、手术总时间及直接清除腋窝淋巴结数之间的关系.方法 采用前瞻性双盲法的干预实验,根据肋间臂神经是否保留将85例乳腺癌患者根据简单随机法随机分为两组.手术是由同等专业资格2名医师采用同样的方法实施,并在术后第2、30、90天进行感觉异常评估.评估方法为调查问卷和神经学检查.结果 在肋间臂神经保留组术后第2、30、90天无症状报告患者分别占16/42、19/41、25/41;而在切除组这一结果为12/43、7/43、12/42.在肋间臂神经保留组术后第2、30、90天无症状患者分别占22/42、16/41、22/41;而在切除组这一结果为5/43、3/43、7/42.结果提示肋间臂神经保留组在以上3个时间点检查结果中手臂感觉异常明显少于对照组(P＜0.05).对手术总时间的对比中发现两种手术时间差异无统计学意义(P=0.76),且两组切除的淋巴结数差异也无统计学意义(P=0.59).在3年随访中,两组中各有1例因去世失访外,两组均未发现肿瘤复发.结论 保留肋间臂神经可减少患者感觉异常发病率,提高患者术后生活质量;同时不会增加手术时间,切除的淋巴结数也不会改变,也不会造成肿瘤复发,因此该手术是安全可行的.
目的 評估乳腺癌腋窩淋巴結清除過程中肋間臂神經保留與手臂疼痛敏感度、手術總時間及直接清除腋窩淋巴結數之間的關繫.方法 採用前瞻性雙盲法的榦預實驗,根據肋間臂神經是否保留將85例乳腺癌患者根據簡單隨機法隨機分為兩組.手術是由同等專業資格2名醫師採用同樣的方法實施,併在術後第2、30、90天進行感覺異常評估.評估方法為調查問捲和神經學檢查.結果 在肋間臂神經保留組術後第2、30、90天無癥狀報告患者分彆佔16/42、19/41、25/41;而在切除組這一結果為12/43、7/43、12/42.在肋間臂神經保留組術後第2、30、90天無癥狀患者分彆佔22/42、16/41、22/41;而在切除組這一結果為5/43、3/43、7/42.結果提示肋間臂神經保留組在以上3箇時間點檢查結果中手臂感覺異常明顯少于對照組(P＜0.05).對手術總時間的對比中髮現兩種手術時間差異無統計學意義(P=0.76),且兩組切除的淋巴結數差異也無統計學意義(P=0.59).在3年隨訪中,兩組中各有1例因去世失訪外,兩組均未髮現腫瘤複髮.結論 保留肋間臂神經可減少患者感覺異常髮病率,提高患者術後生活質量;同時不會增加手術時間,切除的淋巴結數也不會改變,也不會造成腫瘤複髮,因此該手術是安全可行的.
목적 평고유선암액와림파결청제과정중륵간비신경보류여수비동통민감도、수술총시간급직접청제액와림파결수지간적관계.방법 채용전첨성쌍맹법적간예실험,근거륵간비신경시부보류장85례유선암환자근거간단수궤법수궤분위량조.수술시유동등전업자격2명의사채용동양적방법실시,병재술후제2、30、90천진행감각이상평고.평고방법위조사문권화신경학검사.결과 재륵간비신경보류조술후제2、30、90천무증상보고환자분별점16/42、19/41、25/41;이재절제조저일결과위12/43、7/43、12/42.재륵간비신경보류조술후제2、30、90천무증상환자분별점22/42、16/41、22/41;이재절제조저일결과위5/43、3/43、7/42.결과제시륵간비신경보류조재이상3개시간점검사결과중수비감각이상명현소우대조조(P＜0.05).대수술총시간적대비중발현량충수술시간차이무통계학의의(P=0.76),차량조절제적림파결수차이야무통계학의의(P=0.59).재3년수방중,량조중각유1례인거세실방외,량조균미발현종류복발.결론 보류륵간비신경가감소환자감각이상발병솔,제고환자술후생활질량;동시불회증가수술시간,절제적림파결수야불회개변,야불회조성종류복발,인차해수술시안전가행적.
Objective This study aimed to evaluate the relationships between preservation of the intercostobrachial(ICB) nerve and abnormal sensation of the arm,the total time of the surgery,and the number of dissected nodes in patients submitted to axillary lymphadenectomy in surgical treatment of breast cancer.Methods An prospective,randomized,and double blind intervention was performed on 85 patients at the Qinhuangdao Military Hospital in Hebei Province from July 2007 to August 2010.The patients according to whether the ICB nerve was preserved or not were randomly divided into two groups.The surgeries were performed by the same two surgeons.The postoperative evaluations were performed at 2 days,30 days,and 90 days.The abnormal sensation of the arm was subjectively evaluated with an questionnaire and objectively assessed with a neurologic examination.Results In the never preserved group,questionnaire found asymptomatic patients' proportion is up to 16/42,19/41,25/41 after 2 d,30 d and 90 d respectively; while in the resection group the result is 12/43,7/43,12/42.In the never preserved group,neurologic examination reported asymptomatic patients' proportion is up to 22/42,16/41,22/41 after 2 d,30 d and 90 d respectively; while in the resection group the result is 5/43,3/43,7/42.The results suggests that the abnormal sensation propotion in the intercostobrachial nerve preserved group is significantly less than the control group at the three above time points over (P ＜ 0.05).No significant difference was observed on the total time of the surgery and the number of dissected nodes between the two groups.During the 36 months follow up,no local relapse was found in the two groups.Conclusions The research support that the preservation of the ICB nerve is feasible and can lead to a significant decrease in the alteration of abnormal sensation of the arm,without interfering with the total time of the surgery,the number of dissected nodes,and local relapse rate.
