CAJ | 학술논문

目的：探讨乳腺癌手术中溶脂辅助保留肋间臂神经的方法及临床意义。方法：回顾性分析我院2012年1月至2013年1月94例乳腺癌患者临床资料，将94例患者随机分为两组，改良组和对照组。其中改良组50例患者腋窝先经过溶脂后，再行保留肋间臂神经的腋窝淋巴结清扫，对照组44例患者按照常规方法行保留肋间臂神经的腋窝淋巴结清扫，记录两组手术时间、术中淋巴结清扫数量及出血量，观察术后患者上臂感觉功能情况，记录创面冲洗液脱落细胞学检查及随访结果。结果：两组患者术中肋间臂神经主干均完整保留，改良组1例肋间臂神经所属分支被离段，对照组3例出现不同程度肋间臂神经下支、分支离段及电灼伤。术后3周观察患者上臂感觉功能情况，改良组患者中2例出现皮肤麻木，占4.0％；对照组患者中5例出现不同程度的皮肤感觉异常，占11.4％，主要表现为感觉减退、麻木、烧灼感及疼痛，两组比较差异无统计学意义（P ＞0.05）。两组患者在手术时间、清扫淋巴结数目及出血量之间比较差异均有统计学意义（t 分别为12.475，5.648，10.631，均 P ＜0.05）。所有患者随访半年后感觉异常症状均恢复，随访18~30个月未出现局部复发或远处转移，改良组创面冲洗液脱落细胞学检查未见异型细胞。结论：乳腺癌手术中应用溶脂技术保留肋间臂神经是在常规方法的基础上做了改进，操作方便，简单可行，使腋窝血管神经更加清晰，保留肋间臂神经更加容易，而且清扫腋窝淋巴结更彻底，出血量少，缩短了手术时间，患者术后恢复更快，具有一定的临床应用价值，值得推广应用。
목적：탐토유선암수술중용지보조보류륵간비신경적방법급림상의의。방법：회고성분석아원2012년1월지2013년1월94례유선암환자림상자료，장94례환자수궤분위량조，개량조화대조조。기중개량조50례환자액와선경과용지후，재행보류륵간비신경적액와림파결청소，대조조44례환자안조상규방법행보류륵간비신경적액와림파결청소，기록량조수술시간、술중림파결청소수량급출혈량，관찰술후환자상비감각공능정황，기록창면충세액탈락세포학검사급수방결과。결과：량조환자술중륵간비신경주간균완정보류，개량조1례륵간비신경소속분지피리단，대조조3례출현불동정도륵간비신경하지、분지리단급전작상。술후3주관찰환자상비감각공능정황，개량조환자중2례출현피부마목，점4.0％；대조조환자중5례출현불동정도적피부감각이상，점11.4％，주요표현위감각감퇴、마목、소작감급동통，량조비교차이무통계학의의（P ＞0.05）。량조환자재수술시간、청소림파결수목급출혈량지간비교차이균유통계학의의（t 분별위12.475，5.648，10.631，균 P ＜0.05）。소유환자수방반년후감각이상증상균회복，수방18~30개월미출현국부복발혹원처전이，개량조창면충세액탈락세포학검사미견이형세포。결론：유선암수술중응용용지기술보류륵간비신경시재상규방법적기출상주료개진，조작방편，간단가행，사액와혈관신경경가청석，보류륵간비신경경가용역，이차청소액와림파결경철저，출혈량소，축단료수술시간，환자술후회복경쾌，구유일정적림상응용개치，치득추엄응용。
Objective:To study the method and clinical value of preservation of intercostobrachial nerve(ICBN) by fat dissolving method during breast cancer operation. Methods:The clinical data of 94 cases of breast cancer from January 2012 to January 2013 were analyzed retrospectively. 94 patients were randomly divided into two groups,there were 50 patients in modified group,whose ICBN were preserved by fat dissolving method during axillary lymph nodes dissection,and 44 patients in control group,whose ICBN were preserved by routine method during axillary lymph nodes dissection. We recorded the operation times,the number of axillary lymph nodes dissection,bleeding volume, upper arm sensory function,wound flushing fluid exfoliative cytological examination and follow - up results in both groups. Results:ICBN trunk was intactly preserved in all patients,ICBN branch of 1 case was cut off in modified group and varying degrees of ICBN branch damage and electric burn of 3 cases in control group. After postoperative three weeks,we observed upper arm sensory function of patients. It showed that 2 cases of sensory numbness in modi-fied group(4. 0% ),5 cases of sensory abnormality occurred in control group(11. 4% ),mainly as sensory loss, numbness,burning sensation and pain,there was no significant difference between both groups(P > 0. 05). There were significant differences among the data of operation times,number of lymph nodes dissection and bleeding volume in both groups(t = 12. 475,5. 648,10. 631,all P < 0. 05). All patients were followed up for half a year,patients with sensory abnormality recovered. No local recurrence or distant metastasis was found in both groups after 18 ~ 30 months follow - up. Wound flushing fluid exfoliative cytological examination found that there was no atypical cell in modified group. Conclusion:Preserving intercostobrachial nerve by fat dissolving method in breast cancer operation is based on conventional operation and made a few of improvements. It is simple and feasible. During the operation,we find that the axillary neurovascular is clearer,preservation of ICBN is easier,lymph node dissection is more complete,bleeding volume is less,operation time is shorter and postoperative recovery is faster. It is worthy of clinical application.