乳腺癌乳腔镜腋窝淋巴结清除术疗效和预后Meta分析

Meta-analysis of the efficacy and prognosis of breast cancer axillary lymph node dissection with mastoscopy

目的在乳腺手术中,如何使手术获益最大及对患者损伤最小一直是摆在医务工作者面前的严峻问题。随着近年来乳腺手术微创化理念的提出,乳腔镜手术逐渐进入医生视野。本研究分析在乳腔镜和开放手术下行乳腺癌腋窝淋巴结清除术的疗效和预后。方法检索中国生物医学文献数据库、PubMed、中国期刊全文数据库、EmBase、Cochrane Library、维普和万方。采用Cochrane协作网提供的Revman 5.0进行Meta分析。结果乳腔镜手术时间比开放手术长,MD=20.17,95%CI为8.55~31.79,P<0.001;而住院天数(MD=-3.54,95%CI为-4.20^-2.88,P<0.001)、术后引流量(MD=-135.55,95%CI为-167.44^-103.66,P<0.001)、出血量(MD=-41.96,95%CI为-59.48^-24.45,P<0.001)、术后并发症(OR=0.20,95%CI为0.14~0.30,P<0.001)、复发转移率(OR=0.54,95%CI为0.26~1.10,P=0.090)均比开放手术少;而清除淋巴结数量与开放手术相比则差异无统计学意义,MD=-0.19,95%CI为-0.59~0.21,P=0.350。结论乳腔镜下行乳腺癌腋窝淋巴结清除术与开放手术相比具有恢复快、出血量少等优势,且术后并发症及复发转移率均低于开放手术,预后较好。但术者手术熟练度有待提高,且对乳腔镜的远期预后及安全性仍需长期动态观察。

OBJECTIVE In breast surgery,how to maximize the benefit of surgery and minimize the damage to patients has always been a serious problem for doctors.With the introduction of the concept of minimally invasive surgery in breast surgery in recent years,mastoscopic surgery has gradually entered the doctor’s field of vision.This study analyzed the efficacy and prognosis of breast cancer axillary lymph node dissection in breast and open surgery.METHODS Search Chinese Biomedical Literature Database,PubMed,Chinese Journal Full-text Database,EmBase,Cochrane Library,Weipu,Wanfang.Meta analysis was performed using Revman software 5.0 provided by the Cochrane Collaboration.RESULTS The results of the meta-analysis showed that the operation time of the mammoscopy was longer than that of the open surgery(MD=20.17,95%CI:8.55-31.79,P<0.001);and the hospital stay(MD=-3.54,95%CI:-4.20--2.88,P<0.001),postoperative drainage(MD=-135.55,95%CI:-167.44--103.66,P<0.001),bleeding volume(MD=-41.96,95%CI:-59.48--24.45,P<0.001),postoperative complications(OR=0.20,95%CI:0.14-0.30,P<0.001),recurrence and metastasis rate(OR=0.54,95%CI:0.26-1.10,P=0.090)were less than open surgery;there was no significant difference in the number of lymph nodes removed compared with open surgery(MD=-0.19,95%CI:-0.59-0.21,P=0.350).CONCLUSIONS Compared with open surgery,breast cancer axillary lymph node dissection with mastoscopy has the advantages of quick recovery and less bleeding,and the postoperative complications and recurrence and metastasis rate are lower than that of open surgery,and the prognosis is better.However,the surgeon’s surgical proficiency needs to be improved,the long-term prognosis and safety of mastoscopy still require long-term dynamic observation.