目的

探讨保留中、下胸肌神经的乳腺癌改良根治术Ⅱ式(Patey 术)的可行性,并观察手术效果。

方法

回顾性分析2010 年1 月至2011 年3 月在第三军医大学西南医院乳腺外科行保留中、下胸肌神经Patey 术治疗的41 例乳腺癌患者的临床资料。

结果

所有患者均顺利完成该手术。 手术时间为72 ～107 min 之间,平均时间为87 min;术中出血量在15 ～120 ml 之间,平均出血量为75 ml;腋窝淋巴结清扫数量在15 ～42 枚之间,平均清扫23 枚淋巴结;转移淋巴结数目在2 ～32 枚之间,平均转移数为7.7 枚。 全组无皮瓣坏死、切口感染、术后出血等并发症,3 例拔除引流管后出现皮下积液,再次置管行负压引流后痊愈。 术后3 个月随访,所有患者同侧胸大肌外形良好、患侧上肢活动自如。

结论

保留中、下胸肌神经的Patey 术对于术后胸大肌功能的恢复和胸廓形态的维持具有重要意义,是一种具有应用价值的手术方式。

Objective

To explore the feasibility of Patey operation with reservation of medium and inferior pectoral nerves (modified radical mastectomy Ⅱ).

Method

The clinical data of 41 cases undergoing Patey operation with reservation of medium and inferior pectoral nerves between January 2010 and March 2011 in Department of Breast Surgery, Southwest Hospital of the Third Military Medical University were analyzed retrospectively.

Results

The operations were performed successfully in all patients. The mean operation time was 87 min (72-107 min) and the mean blood loss was 75 ml (15-120 ml). The mean number of axillary nodes dissected was 23(15-42) and the mean number of metastatic axillary nodes was 7.7(2-32). There were no postoperative complications including flap necrosis, infection of incision and bleeding. Three cases had subcutaneous effusion after the removal of drainage tube and recovered well by negative pressure drainage. In 3-month follow-up, all patients showed good appearance of ipsilateral major pectoral muscle and the upper extremities on the affected side could move freely.

Conclusion

Patey operation with reservation of medium and inferior pectoral nerves shows great benefit for the postoperative functional recovery of major pectoral muscle as well as the maintenance of thorax, which is worth of clinical application.