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目的比较保留与不保留胸小肌、胸前神经和肋间臂神经的改良乳腺癌根治术的临床疗效。方法回顾性分析我院1996年1月至2004年12月收治的480例乳腺癌,A组280例,采用经胸大肌前入路清扫腋窝淋巴结,保留胸小肌、胸前神经及肋间臂神经;B组200例,经胸大肌后入路清扫腋窝淋巴结,切除胸小肌、切断胸前神经、肋间臂神经,观察随访两组术后情况。结果术后重度胸大肌萎缩者,A组5例(1.8%),B组80例(40.0%);腋窝及内侧上臂感觉异常者,A组18例(6.4%),B组156例(78.0%),两组比较有统计学差异(P<0.01)。术后3、5年生存率,A组分别为81.2%和52.0%,B组分别为82.1%和61.2%,两组比较无统计学差异(P>0.05)。结论保留胸小肌、胸前神经和肋间臂神经的改良乳腺癌根治术,可在保证根治效果的同时提高患者的生活质量。
Objective To compare the clinical efficacy of modified radical mastectomy with or without retained pectoralis minor muscle, anterior chest nerve and intercostobrachial nerve. Methods Retrospective analysis of our hospital from January 1996 to December 2004 treated 480 cases of breast cancer, A group of 280 cases, the anterior approach through the anterior pectoralis major axillary lymph node dissection, retained pectoralis minor muscle, anterior chest nerve and intercostal space The brachial nerve group B (n = 200) was performed axillary lymph node dissection through the posterior pectoralis major muscle, the pectoralis minor muscle was excised, the anterior thoracic nerve and intercostobrachial nerve were cut off, and the postoperative follow-up was observed. Results Acute pectoralis major atrophy was found in 5 cases (1.8%) in group A and 80 cases (40.0%) in group B, with abnormal sensation in axillary and medial upper arm. 18 cases (6.4%) in group A and 156 cases 78.0%). There was a significant difference between the two groups (P <0.01). The 3-year and 5-year survival rates were 81.2% and 52.0% in group A and 82.1% and 61.2% in group B, respectively. There was no significant difference between the two groups (P> 0.05). Conclusion The modified radical mastectomy, which preserves the pectoralis minor muscle, the anterior chest nerve and intercostobrachial nerve, can improve the quality of life of patients while ensuring the curative effect.