乳腺癌患者乳腔镜辅助下腋窝淋巴结清扫术治疗效果的系统评价

Systematic Review of Endoscopic Assisted Axillary Lymph Node Dissection in the Treatment of Breast Cancers

目的系统评价乳腔镜下行腋窝淋巴结清扫术与常规开放性腋窝淋巴结清扫术治疗乳腺癌的效果,为医患双方合理选择术式提供证据。方法计算机检索PubMed、EMBase、中国生物医学文献数据库(CBM)和中国期刊全文数据库(CNKI),并手工检索中、英文已发表的资料和会议论文并追索纳入文献的参考文献,查找比较乳腔镜下行腋窝淋巴结清扫术与常规开放性腋窝淋巴结清扫术治疗乳腺癌的随机对照试验。中文检索词包括:乳腺肿瘤、乳腺癌、腔镜、腋窝淋巴结清扫术、随机、对照。英文检索词包括:breast cancer,breast tumor,randomized controlled tri-al,axillary lymph node dissection,axillary dissection,endoscope,cavity mirrors。对纳入的研究进行方法学质量评价之后,采用RevMan 5.1软件进行Meta分析。结果共纳入7个随机对照试验,合计428例患者。Meta分析结果表明:与常规开放性腋窝淋巴结清扫相比,乳腔镜下行腋窝淋巴结清扫术能减少腋下淋巴引流量〔WMD=-139.02,95%CI(-160.99,-117.05)〕,延长手术时间〔WMD=42.98,95%CI(21.34,64.61)〕,但在术中出血量〔WMD=-21.29,95%CI(-43.34,-0.75)〕、术中清扫淋巴结数目〔WMD=-1.48,95%CI(-3.49,0.52)〕、腋下引流管放置时间〔WMD=-1.58,95%CI(-10.54,7.39)〕、术后并发症〔OR=0.68,95%CI(0.31,1.46)〕、术后住院时间〔WMD=-0.23,95%CI(-0.79,0.33)〕、术后复发〔OR=2.39,95%CI(0.58,9.84)〕方面差异均无统计学意义。结论乳腔镜腋窝淋巴结清扫术具有创伤小、并发症少、术后恢复快、瘢痕小等优点,是目前值得推广的一种手术方法,但乳腔镜手术延长了手术时间,其手术技巧有待进一步提高。由于纳入研究质量普遍较低,上述结论尚需开展更多设计合理、执行严格的多中心大样本且随访时间足够的随机对照试验加以验证。

[ Abstract ] Objective To systematic review the efficacies of endoscopic - assisted axillary lymph node dissection and conventional open axillary lymph node dissection in patients with breast cancer in order to provide evidence for doctors and patients in selecting operation methods. Methods Randomized controlled trials （RCTs） on endoscopic - assisted axillary lymph node dis- section and conventional open axillary lymph node dissection in the treatment of breast cancer were searched from PubMed. EMBase, Chinese biomedical literature database （CBM） and China Jomaaal Full - text Database （ CNKI）, and the relevant published data, conference papers and their references either in English or Chinese were also searched manually. The Chinese searching words were breast tumor, breast cancer, ]aparoscope, axillary lymph node dissection, randomized and controlled. The English searching words were breast cancer, breast tumor, randomized controlled trial, axiUary lymph node dissectiou, axillary dissection, endoscope and cavity mirrors. The data were extracted and the methodological quality of the involved researches was e- valuated by two reviewers independently, and RevMan 5.1 software was used for Meta - analysis. Results A total of 7 RCTs were involved, including 428 patients. Meta analysis showed that compared with conventional open axillary lymph node dissection, endoscopic - assisted axillary lymph node dissection operation could reduce the armpit lymph drainage volume [ WMD = - 139.02, 95% CI （ - 160.99, - 117.05） ], and prolong the operation time [ WMD = 42. 98, 95% CI （21.34, 64. 61 ） ）, but showed no statistically significant differences in the amount of intra - operative bleeding [ WMD = - 21.29, 95% CI （ - 43.34, - 0. 75） ], intra - operative cleaned lymph node number [ WMD = - 1.48, 95% CI （ - 3.49, 0. 52） ], axillary drainage time [WMD=-1.58, 95%CI （-10.54, 7.39）3, post-operative complications [OR=0.68, 95%CI （0.31,1.46） ], post - operative hospitalization time [ WMD = - O. 23, 95% CI （ - O. 79, O. 33 ） ~ and post - operative recurrence [ OR = 2. 39, 95% Ci （0. 58, 9.84） ~ . Conclusion Endoscopic - assisted axillary lymph node dissection should be promoted owing to its advantages of minimal invasion, low complication rate, rapid recovery and invisible scar. However, the surgical technique remains to be further improved to reduce the prolonged operating time. Because of the low quality of the involved resear- ches, the above conclusion still need to be validated by carrying out more randomized controlled trials with multiple centers and bigger sample and enough follow -up time.