van Dam M S, Hennipman A, de Kruif J T, van der Tweel I, de Graaf P W
Academisch Ziekenhuis, afd. Chirurgie, Utrecht.
Ned Tijdschr Geneeskd. 1993 Nov 13;137(46):2395-8.
Axillary dissection in breast cancer is performed to stage the tumor and to obtain regional tumour control. It is associated with some morbidity. Recently mention was made of post-axillary dissection pain of the arm following damage to one or more of the intercostobrachial nerves. In the University Hospital of Utrecht a radical axillary dissection is routinely performed for breast cancer with transection of the sensory intercostobrachial nerve(s). To evaluate the inherent morbidity of this operation, we interviewed and examined 71 women (75 axillae) who had undergone an axillary dissection for carcinoma of the breast between January 1987 and January 1990. In almost all cases a sensory deficit was present in the axilla and/or arm. In 23 patients (26 sides; 35%) there was pain in the arm, always in the innervation area of the intercostobrachial nerves. One-third of these cases had a NRS score of 5 or higher, indicating moderate to severe pain. Seroma and lymphedema were found in 21 patients. In 6 shoulders abduction was reduced to 90 degrees. The several complaints were non-invalidating to 48 patients, slightly invalidating to 13 and moderately invalidating to 10 patients. At present, histological examination of the axillary nodes is still the best way to detect metastases, and it has implications for adjuvant therapies. The results of this study indicate that routinely sacrificing the intercostobrachial nerves during axillary dissection may result in annoying sensory changes and that efforts should be made to preserve one or two of these nerves during the operation.
乳腺癌腋窝清扫术用于肿瘤分期并实现区域肿瘤控制。它会带来一些并发症。最近有人提到腋窝清扫术后因肋间臂神经一条或多条受损导致手臂疼痛。在乌得勒支大学医院，对于乳腺癌常规进行根治性腋窝清扫术，切断感觉性肋间臂神经。为评估该手术的固有并发症，我们对1987年1月至1990年1月间因乳腺癌接受腋窝清扫术的71名女性（75侧腋窝）进行了访谈和检查。几乎所有病例腋窝和/或手臂都存在感觉缺失。23名患者（26侧；35%）手臂疼痛，疼痛部位始终在肋间臂神经的支配区域。其中三分之一的病例数字评分量表（NRS）得分达到或高于5分，表明为中度至重度疼痛。21名患者出现血清肿和淋巴水肿。6例患者肩部外展受限至90度。这些多种不适症状对48名患者无明显影响，对13名患者有轻微影响，对10名患者有中度影响。目前，腋窝淋巴结组织学检查仍是检测转移的最佳方法，且对辅助治疗有影响。本研究结果表明，腋窝清扫术中常规切断肋间臂神经可能导致恼人的感觉改变，手术中应努力保留一两条此类神经。
