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1、乳腺癌改良根治術(shù)后胸大肌功能的肌電評估作者:張士淮,康驊,王玉平 駱成玉,海濤[摘要]目的評價乳腺癌不同改良根治術(shù)后胸大肌功能的變化,并應用肌電對其進行評估,同時探討保留胸前神經(jīng)在乳腺癌改良根治術(shù)中的意義。方法從2001年1月~2003年12月在我院行乳腺癌改良根治術(shù)的患者46例,術(shù)后3個月以上應用肌電圖對胸大肌功能進行檢測。結(jié)果未完整保留胸前神經(jīng)組患側(cè)與健側(cè)胸前神經(jīng)動作電位波幅和傳導速度均存在明顯差異,表現(xiàn)為患側(cè)胸前神經(jīng)動作電位波幅減?。郏?.68±0.65)μVvs(1.35±0.83)μV,P=0.017)],傳導速度減慢[
2、(45.55±16.03)m/svs(54.45±17.40)m/s,P=0.02)];未完整保留胸前神經(jīng)組其潛伏期延長,動作電位波幅減低及傳導速度減慢。Auchincloss術(shù)組內(nèi)患側(cè)胸前神經(jīng)的潛伏期與健側(cè)對比出現(xiàn)延長[(2.94±1.14)msvs(2.60±0.67)ms,P<0.05)]。結(jié)論在乳腺癌改良根治術(shù)中,不論是Auchincloss手術(shù),還是Patey手術(shù)均可能導致術(shù)后胸大肌功能狀態(tài)改變。本研究提示當應用肌電圖對胸大肌功能檢測時,只需測定胸前神經(jīng)的潛伏期、動作電位波幅及傳導速度即可,同時也提示在乳腺癌改良根治術(shù)中
3、有意識地保護胸前神經(jīng)的重要性,這也是保證術(shù)后胸大肌的功能關(guān)鍵所在。[關(guān)鍵詞]乳腺癌;乳腺癌改良根治術(shù);胸大??;胸前神經(jīng);肌電圖10[Abstract]ObjectiveToevaluatethepectoralismajormuscle’sfunctionafterdifferentmodifiedradicalmastectomybyelectromyogramandexplorethesignificanceofpreservingtheanteriorthoracicnerveinmodifiedradicalmastect
4、omy.MethodsForty-sixpatientswithbreastcancerwhohadundergonemodifiedradicalmastectomywereincludedfromJan2001toDec2003.Thefunctionofthepectoralismajormusclewasevaluatedbyusingelectromyogram3monthsormoreaftersurgery.ResultsThemotionpotentialamplitudeofanteriorthoracicner
5、veoftheoperated-sidewasdecreased[(0.68±0.65)μVvs(1.35±0.83)μV,P=0.017)]andtheconductvelocityalsobecameslower[(45.55±16.03)m/svs(54.45±17.40)m/s,P=0.02)]comparedwithnormal-sideinincompletelypreservedanteriorthoracicnervegroup.Thelatentperiodwasdelayed,themotionpotentia
6、lamplitudewasdecreasedandtheconductvelocitybecameslowerintheincompletelypreservedanteriorthoracicnervegroup.Thelatentperiodofoperated-sidewasdelayedcomparedwiththenormal-sideinAuchincloss’soperationgroup[(2.94±1.14)msvs(2.60±0.67)ms,P<0.05)].ConclusionThemodifiedradic
7、almastectomyincludingAuchincloss’soperationandPatey’soperationcouldresultindamagetothefunctionofthe10pectoralismajormuscle.Whenelectromyogramisusedtoexaminethefunctionofthepectoralismajormuscle,werecommendthatthelatentperiod,themotionpotentialamplitudeandtheconductvel
8、ocityoftheanteriorthoracicnerveareexaminedonly.Furthermore,theresultsalsoindicatethatitisveryimportanttocompletelypreserveth