乳房重建中使用扩张器和植入物并发的感染

Use of expanders and implants in breast reconstruction complicated with infection

背景:随着女性对自身审美及治疗需求的提高,乳房重建成为了乳腺癌术后常用的治疗方案,其中扩张器及植入物的使用比例较高。感染作为使用扩张器和植入物最常见的并发症,会导致一系列的后果,甚至影响乳房重建结果。随着对乳房重建中导致感染的风险因素的深入了解、治疗方案的不断完善以及新型材料的应用,可以减少感染的发生,提高乳房重建的成功率。目的:总结在乳房重建中使用扩张器和植入物并发感染的风险因素以及防治措施,并介绍新型材料在乳房重建中的应用前景。方法:通过检索中国知网、万方数据库、PubMed及Web of Science数据库相关文章,以“组织扩张器、植入物、感染、乳房重建”为中文检索词,以“tissue expander,breast implants,breast reconstruction,infection”为英文检索词,然后根据纳入与排除标准对文章进行初筛后,保留相关性和参考价值较高的文章进行综述,最终选择119篇文献进行综述。结果与结论:①基于组织扩张器与植入物的乳房重建在临床上应用广泛,有多种风险因素可能导致乳房重建后感染的发生,严重时引起扩张器与植入物丢失。②乳房重建扩张器和植入物根据其材质特性不同细分为多个种类,其中表面的粗糙程度是影响感染发生的重要原因;虽然光滑表面相较于纹理表面有更高的血清肿发生率,但临床上出现血清肿后通常会提前采取引流以规避其带来的感染风险。③临床医生需结合乳腺重建患者自身健康状况与治疗方式,仔细评估感染发生的概率,合理选择扩张器或植入物,例如对于有多种术前感染因素的患者,选择光滑表面的扩张器或植入物可能更有利于感染的防控。④乳房重建术后预防感染可以使用第二代头孢菌素,必要时可与喹诺酮药物联合使用,而对已经出现感染征象的患者,需及时根据细菌培养情况及药敏实验选择细菌敏感的抗生素进行治疗,尽可能为患者保留扩张器或植入物。⑤目前已经有研究开发出新型乳房重建材料和药物涂层,由于此类产品自身具备抗菌以及抑制细菌附着等优势,可以根本上降低扩张器和植入物感染的发生率,在一些临床个案研究中已显示出了积极的治疗效果,但未来还需进一步采用大样本的随机对照试验来验证。

BACKGROUND:With the improvement of women’s aesthetic and therapeutic needs,breast reconstruction has become a commonly used treatment option after breast cancer surgery,of which the use of expanders and implants is high.Infection,as the most common complication with the use of expanders and implants,can lead to a range of consequences and even affect the results of breast reconstruction.With the deep understanding of the risk factors leading to infection in breast reconstruction,the continuous improvement of treatment options and the application of new materials,the occurrence of infection can be reduced and the success rate of breast reconstruction can be improved.OBJECTIVE:To summarize the risk factors,prevention and treatment measures of infection associated with the use of expanders and implants in breast reconstruction,and to introduce the application prospects of new materials in breast reconstruction.METHODS:Related articles were retrieved on CNKI,Wanfang,PubMed,and Web of Science databases.Search terms were“tissue expander,breast implants,breast reconstruction,infection”in Chinese and English.According to the inclusion and exclusion criteria,after preliminary screening of articles,119 articles with high relevance and reference value were reviewed.RESULTS AND CONCLUSION:(1)Breast reconstruction based on tissue expanders and implants is widely used in clinical practice,and multiple risk factors may lead to the occurrence of infection after breast reconstruction and,in severe cases,to the loss of expanders and implants.(2)Breast reconstruction expanders and implants are subdivided into multiple types according to different material characteristics,of which the roughness of surface is an important cause affecting the occurrence of infection.Although the smooth surface has a higher incidence of seroma than the textured surface,drainage is usually taken in advance to avoid the risk of infection caused by seroma in clinical practice.(3)Clinicians need to carefully evaluate the probability of infection and reasonably select expanders or implants in combination with the health status and treatment methods of breast reconstruction patients.For example,for patients with multiple preoperative infection factors,the selection of smooth surface expanders or implants may be more conducive to the prevention and control of infection.(4)Second-generation cephalosporins can be used to prevent infection after reconstruction,and can be used in combination with quinolones when necessary.For patients who have shown signs of infection,it is necessary to timely select bacteria-sensitive antibiotics for treatment according to bacterial culture and drug sensitivity test,and preserve expanders or implants for patients as far as possible.(5)At present,some studies have developed new breast reconstruction materials and drug coatings.Because such products have their own advantages of antibacterial and inhibition of bacterial attachment,they can fundamentally reduce the incidence of expander and implant infection and have shown positive therapeutic effect in some clinical case studies.However,further randomized controlled trials with large samples are needed to verify it in the future.