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首页> 外文期刊>Vojnosanitetski Pregled >Functional effects of preserving the intercostobrachial nerve and the lateral thoracic vein during axillary dissection in breast cancer conservative surgery
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Functional effects of preserving the intercostobrachial nerve and the lateral thoracic vein during axillary dissection in breast cancer conservative surgery

机译：乳腺癌保守手术腋窝清扫术中保留肋间臂神经和胸外侧静脉的功能作用

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Background/Aim. Conventional axillary dissection in breast cancer surgery implicates the section of the neurovascular elements passing through the dissected tissue: the intercostobrachial nerve (ICBN) and lateral thoracic vein (LTV). Preservation of the ICBN during axillary dissection is well documented in the literature, with slightly contradictory results of its influence to postoperative pain. There is no published data, as far as we know, on the functional effects of preserving the LTV. We supposed that ligation of the LTV contributes to the emergence of postoperative breast edema, which is common in breast cancer conservative surgery. The preservation of venous drainage could diminish the frequency of this undesired occurrence. Methods. In a prospective study, 126 patients undergoing axillary node clearance for breast cancer of stages I and II were randomly selected for preservation of ICBN and LTV (n = 65), or for conventional dissection (n = 61). Sensory deficit, pain and breast edema as a dichotomized characteristics were examined in the first two weeks after the surgery. Results. No difference in the number of dissected nodes was seen between the two groups (p = 0.7). The loss of sensitivity was significantly less common in the group randomized for ICBN preservation (16/65 vs. 30/61, p 0.05). LTV was preserved in 22 patients in the group for preservation, and in none of the control group. Breast edema was registered in 33 patients from the group for preservation (51%) and in 37 patients from the control group (61%). The difference in distribution was not significant, and the same results were obtained when the frequency of breast edema in the group with preserved LTV (22 patients, 10 of them without breast edema) was compared with the all others (p > 0.05). Conclusion. The preservation of the ICBN significantly improved the functional effect of the axillary dissection for breast cancer by reducing sensory loss, while there was no difference in pain intensity and duration. Although we did not prove that the preservation of LTV prevents breast edema after conservative surgery for breast cancer, we think that more complex analysis, including parameters such as the extent of resection of breast tissue, the dimension and constitutional characteristics of the breast, tumor location, obesity, and further developments in surgical technique, would reveal at least discrete improvements in the functional results of this surgical approach.
机译：背景/目标。乳腺癌手术中传统的腋窝夹层牵涉穿过解剖组织的神经血管成分的一部分：肋臂间神经（ICBN）和胸外侧静脉（LTV）。文献中充分记录了腋窝淋巴结清扫期间ICBN的保存，其对术后疼痛的影响略有矛盾。据我们所知，还没有关于保存LTV的功能效果的公开数据。我们认为结扎LTV有助于术后乳房水肿的出现，这在乳腺癌保守手术中很常见。保留静脉引流可减少这种不希望发生的频率。方法。在一项前瞻性研究中，随机选择了126例接受I和II期乳腺癌腋窝淋巴结清扫术的患者，以保存ICBN和LTV（n = 65）或进行常规解剖（n = 61）。在手术后的前两周检查感觉缺陷，疼痛和乳房水肿是否为二分特征。结果。两组之间的解剖结节数没有差异（p = 0.7）。在ICBN保留随机分组中，敏感性丧失的情况明显较少（16/65对30/61，p 0.05）。 LTV被保存在该组中的22名患者中进行保存，而对照组均未保存。该组有33例保留乳腺水肿（51％），对照组有37例（61％）。分布的差异不显着，当将保留LTV的组（22例患者，其中10例无乳腺水肿）与所有其他患者比较时，乳腺水肿的发生频率也获得了相同的结果（p> 0.05）。结论。 ICBN的保存通过减少感觉丧失而显着改善了腋窝淋巴结清扫术对乳腺癌的功能效果，而疼痛强度和持续时间没有差异。尽管我们没有证明保留LTV可以预防乳腺癌保守手术后的乳房水肿，但我们认为分析更为复杂，包括参数，例如切除乳腺组织的程度，乳房的尺寸和结构特征，肿瘤的位置，肥胖症以及手术技术的进一步发展，至少将揭示这种手术方法的功能性结果的离散改善。

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