胸肌前与胸肌后乳房再造术疗效与安全性的meta分析

Meta-analysis of prepectoral and subpectoral breast reconstruction

目的目前对于乳房再造中假体置入的理想平面尚未达成共识,该研究通过meta分析比较胸肌前和胸肌后假体置入的临床疗效和安全性,以求找到更优的手术方法。方法检索PubMed、Cochrane、Web of Science和Embase数据库,检索时限为2019年1月1日至2022年4月1日,收集有关比较乳腺癌乳房切除术后胸肌前乳房再造术(PBR)和胸肌后乳房再造术(SBR)的研究,以各项并发症发生率及乳房美观度为结局指标。由2名研究者独立按照纳入及排除标准进行文献筛选、资料提取、方法学质量评价后,用RevMan 5.3软件对纳入研究进行meta分析。结果共纳入14项研究,包含2355例患者。Meta分析显示PBR和SBR在血清肿、假体取出、皮瓣坏死、包膜挛缩、创面裂开发生率方面差异无统计学意义;在血肿、运动畸形发生率及乳房美观度的BREAST-Q评分方面,PBR更优。结论PBR可能与SBR在临床疗效和安全性方面一样可靠,且在血肿、运动畸形发生率及乳房美观度方面更优于SBR,未来需要开展设计良好的多中心随机对照试验进一步确认。

Objective There is currently no consensus on the ideal plane for implant placement in breast reconstruction.This meta-analysis provides a comparison of prepectoral breast reconstruction(PBR)vs.subpectoral breast reconstruction(SBR),with primary outcomes of surgical efficacy and patient safety,to find out the best surgical approach.Methods PubMed,Cochrane,Web of Science,and Embase databases were searched from January 1st,2019,to April 1st,2022,to retrieve studies that compared PBR with SBR after mastectomies.The main outcomes were surgical complications and satisfaction with breasts domain.The literature was screened according to the inclusion and exclusion criteria,the data was extracted and the methodological quality of the included studies was assessed by 2 reviewers independently.Meta-analysis was performed using RevMan 5.3.Results A total of 14 comparative studies with 2355 patients were included.The meta-analysis showed no statistical differences in seroma,implant removal,flap necrosis,capsular contracture,and wound dehiscence between PBR and SBR groups.PBR patients demonstrated lower hematoma,animation deformity rates,and higher BREAST-Q scores compared to SBR groups.Conclusions Surgical efficacy and patient safety are similar between PBR and SBR groups.PBR patients have lower hematoma,animation deformity rates and are more satisfied with breasts domain.Further well-designed multi-center prospective studies are required to increase the robustness of the findings.