A型肉毒毒素在硅胶假体隆乳术中应用的Meta分析

Meta-analysis of application of botulinum toxin type A in breast augmentation with silicone prosthesis

目的系统评价硅胶假体隆乳术中胸大肌内注射A型肉毒毒素(botulinum toxin type A,BTX-A)对缓解隆乳术后并发症的有效性。方法中国医学科学院北京协和医学院整形外科医院检索自建库至2017年7月Pub Med、中国知网、万方、维普等中英文数据库,收集BTX-A用于硅胶假体隆乳术的随机对照研究(randomized controlled trials,RCTs)和非随机对照研究(non-randomized controlled trials,n-RCTs),提取资料并评价质量后,进行Meta分析。结果共纳入4篇RCTs和2篇n-RCTs,共525例患者。其中3篇文献研究了BTX-A用于缓解术后疼痛的有效性,共331例患者:3篇文献研究了BTX-A用于缓解术后包膜挛缩的有效性,共402例患者;2篇文献研究了BTX-A用于维持乳房形态的有效性,共270例患者。Meta分析结果显示:(1)在术后止痛药服用率方面,BTX-A组显著低于对照组[OR=0.24(95%CI:0.14,0.42),P<0.00001],两组比较差异有统计学意义。(2)在包膜挛缩发生率方面,两组比较差异无统计学意义[OR=0.40(95%CI:0.14,1.13),P=0.08]。(3)在维持乳房形态方面数据不足,无法进行定量分析。结论硅胶假体隆乳术中BTX-A胸大肌注射能缓解患者术后疼痛,但在缓解包膜挛缩和维持乳房形态方面的有效性不明确。该结论有待更多大样本、高质量的RCTs进一步证实。

Objective To systematically evaluate the effectiveness of botulinum toxin type A(BTX-A)injection in pectoralis major in the relieving of postoperative complications of breast augmentation with silicone prosthesis.Methods The databases such as Pub Med,CNKI,Wanfang,and VIP were searched.The retrieval time was from the establishment of the datebase to July 2017.The randomized controlled trials(RCTs)and non-randomized controlled trials(n-RCTs)of BTX-A applied in breast augmentation with silicone prosthesis were collected.After information collection and quality evaluation,the meta-analysis was conducted.Results Four RCTs and2 n-RCTs were involved in this study,with a total of 525 patients.Three literatures studied the effectiveness of BTX-A in the relieving of postoperative pain(n=331)and capsular contracture(n=402);two literatures studied the effectiveness of BTX-A in the maintenance of breast shape(n=270).The meta-analysis results revealed that the utilization rate of analgesic drugs of BTX-A group was significantly lower than that of control group[OR=0.24,95%CI(0.14,0.42),P<0.00001].The difference was statistically significant.There was no statistical difference in the incidence rate of capsular contracture[OR=0.40,95%CI(0.14,1.13),P=0.08].In the maintenance of breast shape,no data can be obtained for quantitative analysis.Conclusion The BTX-A injection in pectoralis major can relieve the postoperative pain of patients underwent breast augmentation with silicone prosthesis.However,the effectiveness in the relieving of capsular contracture and maintaining of breast shape was unclear.Additional large samples and high quality RCTs were needed to confirm this conclusion.