超声引导下穿刺冲洗与切开引流治疗乳腺脓肿的Meta分析

Ultrasound Guided Needle Aspiration and Cavity Washing Versus Incision and Drainage to Treat The Breast Abscesses—Meta Analysis

目的评价超声引导下穿刺冲洗与传统切开引流治疗乳腺脓肿的临床疗效。方法计算机检索中国期刊全文数据库、万方数据库、中国生物医学文献数据库、Pub Med、Cochrane Library、Web of Science和EMbase数据库,同时辅以其他检索。检索时间均从建库至2015年8月下旬,不限语种。收集所有比较超声引导下穿刺冲洗与切开引流治疗乳腺脓肿的随机对照试验(RCTs)。由两名评价员独立按照纳入及排除标准提取数据并交叉核对,采用Cochrane协作网推荐软件Rev Man 5.3版进行统计分析。结果最终纳入8个RCT,共373例患者。Meta分析结果显示:与切开引流组相比,超声引导下穿刺冲洗治疗乳腺脓肿在治愈率〔OR=2.51,95%CI(1.47,4.28),P=0.000 8〕、有效率〔OR=7.45,95%CI(2.29,24.27),P=0.000 9〕、切口愈合时间〔SMD=-1.77,95%CI(-2.09,1.44),P<0.000 01〕、瘢痕长度〔MD=-2.88,95%CI(-3.43,-2.33),P<0.000 01〕和并发症〔OR=0.18,95%CI(0.05,0.62),P=0.007〕方面的差异均有统计学意义。结论与传统切开引流手术相比,超声引导下穿刺冲洗治疗乳腺脓肿有更高的治愈率和有效率、更短的愈合时间、更小的手术瘢痕和更少的术后并发症。

Objective To evaluate the clinical effect of ultrasound guided puncture irrigation and traditional incision and drainage in the treatment of breast abscess. Methods CNKI, Wanfang Database, CBM, Pub Med, Cochrane Library, Web of Science, and EMbase were searched, at the same time complementary with other retrieval in any language to collect the randomized controlled trials（RCTs） about comparison ultrasound guided needle aspiration with incision and drainage to treat the breast abscesses published by late August,2015. Data related to clinical outcomes were extracted by two reviewers independently. Statistical analyses were carried out using Rev Man5.3 software. Results Eight studies were included, which involving 373 participants according to the inclusion criteria. The differences were statistically significant about the cure rate 〔OR=2.51, 95% CI（1.47, 4.28）, P=0.000 8〕, effective rate 〔OR=7.45, 95% CI（2.29, 24.27）,P=0.000 9〕, the heeling time〔SMD=-1.77,95%CI（-2.09,-1.44）,P〈0.000 01〕, the length of the scar 〔MD=-2.88, 95% CI（-3.43,-2.33）, P〈0.000 01〕, and the complications 〔OR=0.18, 95% CI（0.05, 0.62）, P=0.007〕. Conclusions Compared with traditional methods of incision and drainage,ultrasound guided needle aspiration and wash has the more cure rate,the more effective rate,the less heeling time and scars as well as complications.