乳腺癌术后皮下积液防治的最佳证据总结

Summary of best evidences for prevention and treatment of subcutaneous seroma after breast cancer surgery

目的:检索乳腺癌术后皮下积液预防及治疗的已发表文献,以总结其最佳的防治措施。方法:用PIPOST模式确定循证问题,并构建检索策略和纳入、排除标准,然后使用计算机检索中文数据库(知网、万方、维普、中国生物医学文献数据库、医脉通)及英文数据库(Pubmed、Embase、Web of Science、Cochrane、NICE指南网、CINAHL、JBI图书馆、NCCN、ASBrS)中所有关于乳腺癌术后皮下积液相关的防治策略,检索时限为建库至2022年6月10日。由2名经过循证培训的人员对纳入的文献进行独立评价及证据提取。结果:共纳入23篇文献,包括传统综述6篇,专家共识2篇,系统综述15篇。根据证据类型,最终总结出手术技术、药物应用、引流管管理、皮瓣固定、术后活动、皮下积液处理共6个方面30条最佳证据。结论:本研究总结的最佳证据可指导医护人员预防及处理乳腺癌患者术后皮下积液。医护人员应充分考虑临床情境,审慎使用本研究提供的最佳证据对皮下积液患者进行治疗和护理。

Objective:To search for the related literature and summarize the best evidences for preventing and treating subcutaneous seroma after breast cancer surgery.Methods:Following the"PIPOST"model,we identified a question,constructed a search strategy and proposed the inclusion and exclusion criteria.Then we systematically searched the databases in Chinese(CNKI,Wanfang Data,CQVIP,CBM and Medlive)and English(PubMed,Embase,Web of Science,Cochrane Library,National Institute for Health and Care Excellence,Cumulative index to nursing and allied health literature,Joanna Briggs Institute Library,National Comprehensive Cancer Network and American Society of Breast Surgeons)for literature related to prevention and treatment of subcutaneous seroma after breast cancer surgery from the establishment to June 10,2022.Two researchers,who had received evidence-based training,evaluated literature quality and extracted evidence independently.Results:A total of 23 articles were retrieved,consisting of 6 traditional reviews,2 expert consensuses and 15 systematic reviews.We summarized 30 items of evidence and categorized them into 6 aspects:surgical skills,pharmacological treatment,drain management,flap fixation,postoperative exercises and fluid monitoring and removal.Conclusion:The summarized best evidence can provide guidance for preventing and treating subcutaneous seroma after breast cancer surgery.Healthcare professionals should consider real-world clinical settings and cautiously apply the summarized evidence in seroma treatment and nursing.