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背景:在乳房整形术中,要避免因神经损伤所致的乳头、乳晕区感觉和运动障碍,需对乳头、乳晕区的神经分布有详细的了解。目的:观察乳头、乳晕区神经走行和分布,为乳房整形手术提供解剖学资料。设计:单一样本实验。单位:青岛大学医学院人体解剖学教研室及青岛大学医学院附属医院病理科。对象:实验于1999-09/2001-04在青岛大学医学院人体解剖学教研室及青岛大学医学院附属医院病理科进行。观察8具成年女性尸体(20～40岁)的16例乳房标本;10例成年女性乳癌患者(43～58岁)切除的10例(左、右各5例)乳房新鲜标本(患者或家属知情同意)。方法:①应用立体解剖显微镜对16例成年女尸乳房标本进行神经逐层解剖,追踪其在乳腺浅筋膜内的走行和分布。②10例乳房新鲜标本冷冻、切片和苏木精-伊红染色,取典型断面,用体视学方法观察不同层面内4个象限中神经纤维的分布密度。主要观察指标:①乳头、乳晕区的神经分布。②同一标本的不同断面中神经纤维数目。结果:①分布于乳头、乳晕区的神经来自第3、第4、第5肋间神经的外侧皮支和前皮支,以及穿乳腺组织的深支。②第4肋间神经外侧皮支于左乳4点钟,右乳8点钟位置进入乳头、乳晕区,支配乳头的神经主要来自第4肋间神经外侧皮支。③乳头、乳晕外下象限截面内神经纤维数目多于内上、内下和外上象限[(8.06±0.18),(4.63±0.14),(4.43±0.16),(2.13±0.11)条,P<0.01]。④乳头、乳晕区神经分布密度呈向心性递增。结论:胸部手术,尤其是乳房整形术中应尽量避免损伤第3、4、5肋间神经的外侧皮支和前皮支,特别注意保护第4肋间神经外侧皮支和乳头、乳晕区外下象限的神经,以免造成乳头、乳晕区感觉障碍。
Background: In breast augmentation, the nipple, areola zone sensation and dyskinesia due to nerve damage should be avoided and a detailed understanding of the nerve distribution in the nipple and areola area is needed. Objective: To observe the movement and distribution of the nerve in the nipple and areola area and provide anatomical data for breast plastic surgery. Design: Single sample experiment. Unit: Department of Human Anatomy, Medical College of Qingdao University, and Department of Pathology, Affiliated Hospital of Qingdao University Medical College. PARTICIPANTS: The experiment was performed at Department of Human Anatomy, School of Medicine, Qingdao University, and Department of Pathology, Affiliated Hospital of Qingdao University Medical College from September 1999 to April 2001. Sixteen breast specimens of 8 adult female bodies (20-40 years old) were observed; 10 fresh breast specimens (5 cases of left and right) resected from 10 adult female breast cancer patients (43-58 years old) agree). Methods: (1) 16 adult female corpse breast specimens were anatomized nerves by stereotactic microscope and their movement and distribution in the superficial fascia of the breast were observed. ② Fresh samples from 10 breast tissues were frozen, sectioned and stained with hematoxylin-eosin, and the typical sections were taken. The distribution density of nerve fibers in 4 quadrants in different layers was observed by stereological methods. MAIN OUTCOME MEASURES: ①Nerve distribution in nipple and areola area. ② the same specimen in different sections in the number of nerve fibers. Results: ①Nerve distributed in the nipple and areola area were from the lateral and anterior cutaneous branches of the 3rd, 4th and 5th intercostal nerves, and the deep branches of the breast tissue. The fourth intercostal nerve lateral cutaneous branches in the left breast 4 o'clock, right breast 8 o'clock position into the nipple, areola area, dominant nipple nerve mainly from the fourth intercostal nerve lateral cutaneous branch. ③ The number of nerve fibers in the outer quadrant of the nipple and areola was more than that of the upper, lower and upper quadrants [(8.06 ± 0.18), (4.63 ± 0.14), (4.43 ± 0.16), (2.13 ± 0.11), P <0.01]. ④ nipple, areola area nerve distribution density was concentric increase. CONCLUSIONS: Thoracic surgery, especially in breast augmentation, should be done to avoid damage to the lateral and anterior cutaneous branches of intercostal nerves 3, 4 and 5 with special attention to protecting the lateral branch of the intercostal nerve 4 and the nipple, Lower quadrants of the nerves, so as to avoid nipple, areola area sensory disturbance.