Keep The Chest, Intercostobrachial Nerve In Axillary Clinical Study Of Lymph Node Dissection

Breast cancer is the most common malignant tumor in women’s diseases. Inrecent years, female breast cancer prevalence increased in constant development, theincidence of breast cancer increased gradually has attracted worldwide attention,According to the statistics in our country a lot of city of breast cancer incidence wassignificantly increased, has become the first female malignancy, serious impact onwomen’s physical and mental health and quality of life. Judging from the currentsituation of breast cancer is a most common malignant tumor in women.20-relateddeath in malignant tumor at the age of59female breast cancer is the most common. Accordingto the American Cancer Society estimates, number of new cases of breast cancer in2010America will exceed200000, the death toll of more than40000of total cancerdeaths, mortality rate14.1%. Statistical data in China, from1982to2001, theincidence of breast cancer in Beijing area of the rate of growth of91%, averageannual growth of4.6%. Display by Yang Ling in2006China study: women with breast cancerfrom2000to2005, the incidence and mortality of5years showed an upward trend, theincidence increased by38.5%, the death toll rose37.1%. According to the two nationalmortality retrospective survey data shows, the upward trend in young women withbreast cancer mortality, is nearly15years leading causes of mortality rate of breastcancer in China continued to rise. Moreover, China’s population growth and aging, but also improve the important cause of breast cancer mortality.The middle of the twentieth Century, the theory of biological characteristics ofbreast cancer appears gradually replaced by anatomical concept as the guideline, thisperiod of surgical treatment of breast cancer appears new turning point. From theclassic Halsted radical operation to the development of modified radical operation ofbreast conserving operation, and minimally invasive operation, in order to ensure theeradication of tumor, improve the quality of life of patients with breast cancer afteroperation, as far as possible to retain the function of upper limbs, become the finalgoal in the surgical treatment of breast cancer. At present, breast modified radicalmastectomy surgery mainly classical Chinese style is still. Modified radicalmastectomy for breast cancer in general only keep long thoracic nerve andthoracodorsal nerve to prevent postoperative posterior latissimus muscle atrophy, andintercostobrachial nerve and anterior thoracic nerve in the removal of axillary lymphnode in the process is removed. But easy to postoperative chest wall and medial armnumbness, pain, muscle atrophy, limb edema and dysfunction and othercomplications, long recovery time can’t even return.In short, breast cancer axillary lymphadenectomy in addition to conventionalretention long thoracic and dorsal thoracic nerve, while preserving anterior thoracicnerve and intercostobrachial nerve, observe the postoperative chest size musclefunction, the survival rate of the flap, the ipsilateral arm sensory dysfunction.Summed up the breast cancer axillary lymph node cleaning necessity and clinicaleffect of preserving anterior thoracic nerve and intercostobrachial nerve duringoperation, to reduce postoperative complications, improve the quality of life ofpatients, clinical significance.ObjectiveStudy of breast cancer axillary lymphadenectomy in addition to conventionalretention long thoracic and dorsal thoracic nerve, while preserving anterior Thoracicnerve andintercostobrachial nerve during operation, intraoperative attention to retainICBN and ATN can significantly improve the complications. Clinical effect of postoperative satisfaction, worthy of application. Summed up the breast canceraxillary lymph node cleaning necessity and clinical effect of anterior thoracic nerveand Intercostobrachial nerves. To reduce the postoperative complications, improve thequality of life of patients.Materials and methodsFrom2012December to2013statistical and clinical data of December in theThird Affiliated Hospital of Zhengzhou University Department of breast modifiedradical mastectomy was done in100cases data, clinical stage Ⅰ-Ⅲ period, givestatistical grouping. Case information into preservation group preserving anteriorthoracic nerve and intercostobrachial nerve during operation (50cases) and controlgroup (50cases) were not preserve the anterior thoracic nerve and intercostobrachialnerve. Two groups were observed after the chest size muscle function, with differentside arm sensory dysfunction, pain, retrospective study. Statistical analysis wasperformed using SPSS17.0statistical software, and x2test was used to test thestatistical data. Two independent sample compared with T-test, correlation analysisusing linear correlation, P <0.05with significant difference.ResultsThis group of breast cancer patients with a total of100patients were female, age22-78years old, operation underwent modified radical mastectomy of breast cancer.Divided into preservation group preserving anterior thoracic nerve andintercostobrachial nerve during operation (50cases) and control group (50cases)were not preserve the anterior thoracic nerve and intercostobrachial nerve werecomprehensively compared. And the control group were observed postoperatively3,6,12months retention group.1. the comparison between the two groups in the change of muscle atrophy andmuscle atrophy: shape retention group2cases, were mild atrophy.16cases of thecontrol group, the two groups were compared the differences were statisticallysignificant (x2=21.75, P <0.05). Changing the shape of the chest wall: keep the group 0cases, control group18cases, the thoracic skin collapse in12cases, thoracic in6cases. The two groups were compared the differences were statistically significant(x2=23.98, P <0.05).2.Comparison of2two groups of upper arm on the affected side and axillaryskin sensory dysfunction: keep the group of3cases, including1cases of onlyaffected arm numbness of skin,2cases of upper arm and armpit skin numbness. Acontrol group of17cases appeared ipsilateral upper arm and axillary skin numbness.The two groups were compared the differences were statistically significant(x2=19.97, P <0.05).3. two groups of pain in the affected side upper arm and axillary region,preserving group:2patients with axillary pain, feeling lighter tolerated. A controlgroup of8cases of axillary fossa pain. The two groups were compared thedifferences were statistically significant (x2=17.62, P <0.05).4. group two metastasis in tumor recurrence and axillary comparison: preservinggroup without recurrence and axillary metastasis in the observation period. In1casesof the control group after1years when the metastasis of supraclavicular axillary.Comparing the two groups had no significant difference was not statisticallysignificant (x2=4.62, P>0.05).5. The two group in upper limb weight-bearing comparison: preserving group:upper limb after operation can be normal weight, daily life is not limited. Controlgroup:14cases of postoperative weight-bearing restriction, upper extremity weakness.Limited daily farm work or heavy manual labour.3months after operation in8cases,6months after operation in4cases,12months after operation in2cases. The twogroups were compared the differences were statistically significant.(x2=26.73, P <0.05).Conclusions1. axillary lymphadenectomy retention group and control group were observedafter3,6,12months. Preserving group pectoral muscle in good shape, no obviousatrophy, limb weight-bearing activities function is good, and the not preserving group differences.2. retention group and control group were observed after3,6,12months.Preserving group ipsilateral medial arm and axilla without obvious skin sensorydisturbance and pain, and the not preserving group differences.3. retention group and control group were observed after3,6,12months. Tumorrecurrence and metastasis has no significant difference between the two groups.