乳腺癌术后不同乳房再造方法并发症的Meta分析

Complications in different breast reconstruction methods after breast cancer surgery:a Meta-analysis

目的评估乳房重建术式与术后并发症的关系。方法计算机检索Pubmed、Embase、Medline、Cochrance、WangFang、CNKI、万方及维普数据库,检索1990年1月至2017年11月已发表的应用横行腹直肌肌皮瓣、腹壁下动脉穿支皮瓣、背阔肌肌皮瓣、背阔肌肌皮瓣联合假体、单纯假体置入5种常用的乳房重建术式术后并发症的中英文文献,采用RevMan 5.3进行Meta分析。结果纳入研究文献29篇。横行腹直肌肌皮瓣法术后出现皮瓣局部坏死、血清肿、感染、脂肪液化、腹壁疝及供区腹壁膨隆并发症高于腹壁下动脉穿支皮瓣法,差异有统计学意义(P<0.05)。横行腹直肌肌皮瓣法出现术后皮瓣全部坏死、伤口裂开、感染并发症高于背阔肌肌皮瓣法,其出现术后血清肿低于背阔肌肌皮瓣法,结果均有统计学意义(P<0.05)。背阔肌肌皮瓣+假体置入法出现术后血清肿高于单纯假体置入法,其在术后假体包膜挛缩、假体移位要低于单纯假体置入法,结果均有统计学意义(P<0.05)。结论腹壁下动脉穿支皮瓣具有横行腹直肌肌皮瓣的优点,并发症少。临床上应根据患者自身情况选择并发症较低的乳房重建术。

Objective To evaluate the relationship between breast reconstruction and postoperative complications by meta-analysis.Methods Through a defined search strategy,related literature was collected in databases from PubMed,MEDLINE,EMBASE,Cochrane,CNKI,Wanfang Database and VIP Database,from January 1990 to November 2017.Data were extracted and each merged data was analyzed using RevMan 5.3 software.The postoperative complications between transverse rectus abdominis musculocutaneous-flap(TRAM)and deep inferior epigastric perforatorflap(DIEP),TRAM and latissimus dorsiflap(LDF),LDF and LDF+prosthesis,LDF+prosthesis and simple prosthesis implantation were compared.Results Twenty-nine papers met inclusion criteria of our study.The Meta-analysis results showed that the risk of local flap necrosis,seroma,infection,fat liquefaction,abdominal wall hernia and abdominal bulging in TRAM group were higher than those in DIEP group,and the differences were significant.There was no significant difference in total flap necrosis,wound dehiscence,venous congestion between the two groups;the risk of total flap necrosis,wound dehiscence and infection in TRAM group were higher than those in LDF group,and the differences were significant.The risk of seroma in TRAM group was lower than that in LDF group,and the differences were significant.There was no significant difference in fat liquefaction between the two groups;there was no significant difference in the postoperative complications between LDF group and LDF+prosthesis group;the risk of seroma in LDF+prosthetic group was higher than that in prosthetic group,and the differences was significant.The risk of prosthetic capsular contracture and prosthesis displacement in LDF+prosthetic group were lower than those in prosthetic group,and the differences were significant.There was no significant difference in prosthesis exposure and infection between the two groups.Conclusions DIEP has most of the advantages of TRAM and fewer complications.It plays an important role in breast reconstruction in the future.We should make a choice of breast reconstruction methods according to the patient's conditions as far as possible in clinical practice.