Application Value of Ultrasound Knife in Modified Radical Mastectomy of Breast Cancer for Remaining Pectoral Nerve and Intercostobrachial Nerve_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 DUGuo-cheng ¹ , ZHANGMao-chun ² , LIUZhen-zhen ¹ , ZHUKe-peng ¹ , YIWen ¹ , ZHUDong-mei ³

1. Department of General Surgery, Nanchong Central Hospital, Nanchong 637000, Sichuan Province, China;
2. Department of Ultrasound, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China;
3. Department of Ultrasound, Nanchong Central Hospital, Nanchong 637000, Sichuan Province, China;

Corresponding?author：

DUGuo-cheng, Email: dgc750504@163.com

Keywords：

Ultrasound knife; Breast cancer; Modified radical mastectomy; Pectoral nerve; Intercostobrachial nerve

DOI：

10.7507/1007-9424.20150059

Video：

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Objective To investigate the value of ultrasound knife in modified radical mastectomy for remaining pectoral nerve and intercostobrachial nerve. Methods One hundred and sixty patients with breast cancer were divided into ultrasound knife group and electroscalpe group and then performed modified radical mastectomy with pectoral nerve and intercostobrachial nerve remainning. the pectoralis major thickness and paresthesia of skin of inner upper arm and axillary fossa were detected on the different time after operation. Results ①The age, body mass index, and mean opera-tion time had no significant differences between these two groups (P > 0.05).②On 6 months after operation, the thickness of bilateral pectoralis major was not significantly different in the ultrasound knife group (P > 0.05), which of injuried pectoralis major was significantly thinner than that of uninjuried pectoralis major in the electroscalpe group (P < 0.05).③The rates of paresthesia of skin on postoperative 3 months and 6 months in the ultrasound knife group were signifi-cantly lower than those in the electroscalpe group (P < 0.05). Conclusion Compared with monopolar electro diathermy, the use of ultrasonic harmonic scalpel in modified radical mastectomy could better protect pectoral nerve and intercosto-brachial nerve, and thus decrease nerve parafunctional rate.

Citation： DUGuo-cheng, ZHANGMao-chun, LIUZhen-zhen, ZHUKe-peng, YIWen, ZHUDong-mei. Application Value of Ultrasound Knife in Modified Radical Mastectomy of Breast Cancer for Remaining Pectoral Nerve and Intercostobrachial Nerve. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(2): 220-223. doi: 10.7507/1007-9424.20150059 Copy

1.	?鄭瑩, 吳春曉, 張敏璐.乳腺癌在中國的流行狀況和疾病特征.中國癌癥雜志, 2013, 23(8): 561-569.
2.	許紅, 毛德強, 王燕.重慶市女性腫瘤發病率及年齡特征分析.重慶醫學, 2010, 39(11): 1422-1423, 1447.
3.	吳祥德, 董守義.乳腺疾病診治.第2版.北京:人民衛生出版社, 2009: 176-179.
4.	Loukas M, Louis RG, Fitzsimmons J, et al. The surgical anatomy of the ansa pectoralis. Clin Anat, 2006, 19(8): 685-693.
5.	吳誠義, 姚榛祥, 吳凱南, 等.乳腺癌腋清掃術中保留肋間臂神經的方法和意義.外科理論與實踐, 2001, 6(4): 210-212.
6.	Ivanovi? N, Grani? M, Randelovi? T, et al. Functional effects of preserving the intercostobrachial nerve and the lateral thoracic vein during axillary dissection in breast cancer conservative surgery. Vojnosanit Pregl, 2007, 64(3): 195-198.
7.	支珍, 劉小敏, 孫利國, 等.乳腺癌根治術保留肋間臂神經臨床價值分析.中國實用外科雜志, 2009, 2(2): 160-161.
8.	中華人民共和國衛生部.乳腺癌診療規范(2011年版).衛辦醫政發〔2011〕78號.
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10.	郭仁宣.乳腺外科學.沈陽:遼寧科學技術出版社, 2003: 7.
11.	Kanehira E, Omura K, Kinoshita T, et al. How secure are the arteries occluded by a newly developed ultrasonically activated device? Surg Endosc, 1999, 13(4): 340-342.
12.	Kakarala K, Faquin WC, Deschler DG. A comparison of histopathologic margin assessment after steel scalpel, monopolar electrosurgery, and ultrasonic scalpel glossectomy in a rat model. Laryngoscope, 2010, 120 Suppl 4: S155.
13.	陳潔, 曾荷琳, 呂青, 等.超聲刀在乳腺癌Auchincloss改良根治術中應用的隨機對照研究.華西醫學, 2011, 26(7): 965-967.
14.	肖祥勝, 李峻, 張麗娟, 等.超聲刀在乳腺癌改良根治術中的應用.實用醫學雜志, 2010, 26(23): 4365-4366.
15.	韓中保, 周羽, 韓扣蘭.乳腺癌根治術保留肋間臂神經對患者術后生存質量的影響.中國臨床解剖學雜志, 2011, 29(5): 591-593, 596.
16.	陸深泉, 劉濤.乳腺癌改良根治術中保留肋間臂神經療效的近期觀察.中國普外基礎與臨床雜志, 2012, 19(9): 995-997.
17.	吳瑞正, 齊曉偉, 張帆.保留中、下胸肌神經的Patey手術41例分析.中華乳腺病雜志:電子版, 2013, 7(4): 12-14.
18.	Macdonald L, Bruce J, Scott NW, et al. Long-term follow-up of breast cancer survivors with post-mastectomy pain syndrome. Br J Cancer, 2005, 92(2): 225-230.
19.	辛玲, 馮藝.乳腺癌術后疼痛綜合征的前瞻性研究及相關因素分析.中國疼痛醫學雜志, 2013, 19(3): 159-163.
20.	Andersen KG, Aasvang EK, Kroman N, et al. Intercostobrachial nerve handling and pain after axillary lymph node dissection for breast cancer. Acta Anaesthesiol Scand, 2014, 58(10): 1240-1248.
21.	Freeman SR, Washington SJ, Pritchard T, et al. Long term results of a randomised prospective study of preservation of the intercostobrachial nerve. Eur J Surg Oncol, 2003, 29(3): 213-215.

1. ?鄭瑩, 吳春曉, 張敏璐.乳腺癌在中國的流行狀況和疾病特征.中國癌癥雜志, 2013, 23(8): 561-569.
2. 許紅, 毛德強, 王燕.重慶市女性腫瘤發病率及年齡特征分析.重慶醫學, 2010, 39(11): 1422-1423, 1447.
3. 吳祥德, 董守義.乳腺疾病診治.第2版.北京:人民衛生出版社, 2009: 176-179.
4. Loukas M, Louis RG, Fitzsimmons J, et al. The surgical anatomy of the ansa pectoralis. Clin Anat, 2006, 19(8): 685-693.
5. 吳誠義, 姚榛祥, 吳凱南, 等.乳腺癌腋清掃術中保留肋間臂神經的方法和意義.外科理論與實踐, 2001, 6(4): 210-212.
6. Ivanovi? N, Grani? M, Randelovi? T, et al. Functional effects of preserving the intercostobrachial nerve and the lateral thoracic vein during axillary dissection in breast cancer conservative surgery. Vojnosanit Pregl, 2007, 64(3): 195-198.
7. 支珍, 劉小敏, 孫利國, 等.乳腺癌根治術保留肋間臂神經臨床價值分析.中國實用外科雜志, 2009, 2(2): 160-161.
8. 中華人民共和國衛生部.乳腺癌診療規范(2011年版).衛辦醫政發〔2011〕78號.
9. 霞富士雄.技巧與誤區:乳腺外科要點與盲點.沈陽:遼寧科學技術出版社, 2005: 5.
10. 郭仁宣.乳腺外科學.沈陽:遼寧科學技術出版社, 2003: 7.
11. Kanehira E, Omura K, Kinoshita T, et al. How secure are the arteries occluded by a newly developed ultrasonically activated device? Surg Endosc, 1999, 13(4): 340-342.
12. Kakarala K, Faquin WC, Deschler DG. A comparison of histopathologic margin assessment after steel scalpel, monopolar electrosurgery, and ultrasonic scalpel glossectomy in a rat model. Laryngoscope, 2010, 120 Suppl 4: S155.
13. 陳潔, 曾荷琳, 呂青, 等.超聲刀在乳腺癌Auchincloss改良根治術中應用的隨機對照研究.華西醫學, 2011, 26(7): 965-967.
14. 肖祥勝, 李峻, 張麗娟, 等.超聲刀在乳腺癌改良根治術中的應用.實用醫學雜志, 2010, 26(23): 4365-4366.
15. 韓中保, 周羽, 韓扣蘭.乳腺癌根治術保留肋間臂神經對患者術后生存質量的影響.中國臨床解剖學雜志, 2011, 29(5): 591-593, 596.
16. 陸深泉, 劉濤.乳腺癌改良根治術中保留肋間臂神經療效的近期觀察.中國普外基礎與臨床雜志, 2012, 19(9): 995-997.
17. 吳瑞正, 齊曉偉, 張帆.保留中、下胸肌神經的Patey手術41例分析.中華乳腺病雜志:電子版, 2013, 7(4): 12-14.
18. Macdonald L, Bruce J, Scott NW, et al. Long-term follow-up of breast cancer survivors with post-mastectomy pain syndrome. Br J Cancer, 2005, 92(2): 225-230.
19. 辛玲, 馮藝.乳腺癌術后疼痛綜合征的前瞻性研究及相關因素分析.中國疼痛醫學雜志, 2013, 19(3): 159-163.
20. Andersen KG, Aasvang EK, Kroman N, et al. Intercostobrachial nerve handling and pain after axillary lymph node dissection for breast cancer. Acta Anaesthesiol Scand, 2014, 58(10): 1240-1248.
21. Freeman SR, Washington SJ, Pritchard T, et al. Long term results of a randomised prospective study of preservation of the intercostobrachial nerve. Eur J Surg Oncol, 2003, 29(3): 213-215.

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Application Value of Ultrasound Knife in Modified Radical Mastectomy of Breast Cancer for Remaining Pectoral Nerve and Intercostobrachial Nerve

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