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目的:探讨保留肋间臂神经与切除肋间臂神经在乳腺癌改良根治术中的临床意义,为制定临床合理的个体化手术方案提供证据。方法:制定原始文献的纳入标准、排除标准及检索策略,搜索关于保留肋间臂神经在乳腺癌改良根治术中的价值和意义方面的临床随机对照试验。检索日期由2000年1月—2012年2月。按cochrane系统评价方法,评价所纳入研究的文献质量,并提取有效数据后采用RevMan5.0软件进行Meta分析。结果纳入12项研究,共计1146例患者。结果:保留肋间神经可以明显减轻患者上臂内侧感觉功能(随访1个月,3个月,12个月OR1=0.15,95%CI:0.10~0.21;OR3=0.06,95%CI:0.03~0.10;OR12=0.07,95%CI:0.03~0.16)),保留肋间臂神经手术时间较切除肋间臂神经在乳腺癌改良根治所用的时间略延长(MD=6.75,95%CI:3.88~9.26);随访1~3年乳腺癌局部复发率两种术式术中出血量、清除淋巴结数、术后肩关节运动障碍及皮下积液切除ICBN与保留ICBN均没有明显的差异。结论:保留肋间臂神经可以明显减轻乳腺癌改良根治术后患侧上臂内侧感觉功能障碍、延长手术时间但对乳腺癌复发率没有明显影响。
Objective: To investigate the clinical significance of preserving intercostobrachial nerve and excision of intercostobrachial nerve in modified radical mastectomy for breast cancer, and to provide evidence for the development of a clinically rational individualized surgical program. Methods: To establish the inclusion criteria, exclusion criteria and search strategies of original documents, and to search for clinical randomized controlled trials on the value and significance of preserving intercostobrachial nerve in radical mastectomy of breast cancer. Retrieval date from January 2000 - February 2012. According to the cochrane systematic evaluation method, the quality of the included literature was evaluated, and the validated data were extracted and analyzed by RevMan5.0 software. Results A total of 1146 patients were enrolled in 12 studies. Results: The preservation of intercostal nerve could significantly reduce the sensory function of the upper arm of the patients (OR1 = 0.15,95% CI: 0.10-0.21; OR3 = 0.06,95% CI: 0.03-0.10 for 1 month, 3 months and 12 months follow- ; OR12 = 0.07, 95% CI: 0.03-0.16)), the duration of operation for intercostobrachial nerve reservation was slightly longer than that for excision of intercostobrachial nerve in radical mastectomy (MD = 6.75,95% CI: 3.88-9.26 ). Follow-up 1 to 3 years The local recurrence rate of breast cancer There was no significant difference between the two operations in the amount of bleeding, the number of lymph nodes removed, the shoulder joint dyskinesia and subcutaneous fluid excision of ICBN and reserved ICBN. CONCLUSION: The preservation of intercostobrachial nerve can significantly reduce the sensory dysfunction of medial upper arm after modified radical mastectomy, prolong the operation time but have no obvious effect on the recurrence rate of breast cancer.