真空辅助旋切术治疗无异形乳腺导管内乳头状瘤的疗效与预后的Meta分析

Efficacy and prognosis of vacuum-assisted excision for benign intraductal papilloma of breast:A meta-analysis

目的:评价真空辅助旋切术治疗无异形乳腺导管内乳头状瘤的安全性及有效性。方法:检索PubMed、Embase、Cochrane Library、万方医学、中国知网、维普、中国生物医学文献服务系统等电子数据库,按照纳入与排除标准筛选文献后,使用Cochrane手册及纽卡斯尔-渥太华量表进行文献质量评价,采用Review Manager 5.3软件进行效应量的合并分析。结果:最终纳入9篇文献,共1016例患者。真空辅助旋切手术对比开放手术出血量少[MD=-6.38,95%CI(-9.90,-2.86),P<0.05];术后并发症少[RR=0.43,95%CI(0.29,0.64),P<0.05];术后引流量[MD=-2.56,95%CI(-4.97,-0.15),P<0.05]及引流时间[MD=-0.25,95%CI(-0.40,-0.09),P<0.05]均低于开放组;术后复发率低[RR=0.26,95%CI(0.14,0.49),P<0.05],但在手术时间上与开放手术相比则差异无统计学意义[SD=-12.82,95%CI(-25.70,0.06),P=0.05]。结论:真空辅助旋切术比开放手术具有出血量少、术后引流量少及引流时间短、术后并发症少的优势,但在手术时间上与开放手术相比则无统计学意义,另外本研究在复发率的对比上真空微创旋切术显示了复发率低的优势,但仍需长期动态观察。

Objective:To evaluate the safety and effectiveness of vacuum-assisted excision for benign intraductal papilloma of breast.Methods:The databases including PubMed,Embase,Cochrane Library,WangFang,CNIK,VIP and Web of Science were searched by computer,according the inclusion and exclusion criteria after screening of literature.The Cochrane handbook and Newcastle-Ottawa scale was used to evaluate the studies.Then the Review Manager 5.3 software was to used analyze the data.Results:A total of 1016 patients was included in 9 articles.The amount of blood loss in vacuum-assisted surgery was less than that in open surgery[MD=-6.38,95%CI(-9.90,-2.86),P<0.05].The drainage[MD=-2.56,95%CI(-4.97,-0.15),P<0.05]and drainage time[MD=-0.25,95%CI(-0.40,-0.09),P<0.05]in vacuum-assisted surgery was less than that in open surgery.There were also few postoperative complications than that in open surgery[RR=0.43,95%CI(0.29,0.64),P<0.05].Compared with open surgery,the postoperative recurrence rate was lower in vacuum-assisted surgery[RR=0.26,95%CI(0.14,0.49),P<0.05].Last,there was no statistically significant difference in the operative time between vacuum-assisted surgery and open surgery,[SD=-12.82,95%CI(-25.70,0.06),P=0.05].Conclusion:Compared with open surgery,vacuum-assisted excision has the advantages of less blood loss and lower postoperative complications,but the operative time is not statistically significant compared with open surgery.In addition,compared with open surgery in this study,vacuum-assisted excision has the advantages of lower recurrence rate,but it still needs long-term dynamic observation.