保乳术与改良根治术治疗乳腺癌患者临床疗效及预后影响的系统评价  

Clinical efficacy and prognosis of breast cancer between breast conserving surgery and modified radical mastectomy: A systematic review

作　　者：余敏[1] 徐正丰[1] 邱涵[1] 董超[1] 

机构地区：[1]荆州市中心医院乳腺外科,湖北荆州434020

出　　处：《安徽医药》2015年第12期2330-2334,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨保乳术与改良根治术对于乳腺癌患者的临床疗效及预后影响的差异性。方法通过检索自1995年1月至2015年1月期间万方数据库等常用数据库内相关的随机对照试验(RCT),对纳入文献的质量进行严格评价和资料提取,使用Stata/SE version 12.0软件对纳入研究进行系统评价。结果最终纳入10篇RCT,共731例患者,其中实验组患者(保乳术)342例、对照组患者(改良根治术)389例。系统评价结果显示:相比对照组患者,接受保乳术行外科治疗的乳腺癌患者,其手术耗时显著缩短[P<0.001、I2=96.9%、SMD=-1.48、95%CI=(-2.69,-0.27)],结果稳健[bias_p=0.373、bias_95 CI=(-8.944372,20.98433)];手术中出血量显著减少[P<0.001、I2=96.3%、SMD=-2.37、95%CI=(-3.50,-1.25)],结果稳健[bias_p=0.248、bias_95 CI=(-15.77378,4.808581)];术后随访3年复发率未见显著变化[P=0.983、I2=0、RR=1.27、95%CI=(0.44,3.68)],结果稳健[bias_p=0.317、bias_95 CI=(-0.2657797,1.462447)];术后随访5年复发率未见显著变化[P=0.983、I2=0%、RR=1.18、95%CI=(0.44,3.17)],结果稳健[bias_p=0.234、bias_95 CI=(-5.125295,11.72263)]。结论乳腺癌患者应用保乳术行外科治疗,可显著降低患者的手术耗时和术中出血量,并且对预后不产生显著改变,值得临床推广。Objective To explore the differences in clinical efficacy and prognosis of breast cancer patients by breast- conserving surgery or modified radical mastectomy. Methods We have searched for related articles of randomized controlled trials（ RCT） in the commonly used database,published between January 1995 to January 2015. The quality of the literature was assessed strictly and Stata/ SE version 12. 0 software was used to carry out systematic reviews. Results Ten RCTs were included,involving a total of 731 patients,of whom342 cases were in experimental group（ breast- conserving surgery）,and 389 cases were incontrol group（ modified radical mastectomy）. System evaluation results showed that compared with the control group,the experimental group was more significant in the following areas： Operation time was significantly shortened[P 0. 001,I2= 96. 9%,SMD =- 1. 48,95% CI =（- 2. 69,- 0. 27） ],with a stable result[bias_p = 0. 373,bias_95 CI =（- 8. 944372,20. 98433） ]; Surgery bleeding was significantly shortened[P 0. 001,I2= 96. 3%,SMD =- 2. 37,95% CI =（- 3. 50,- 1. 25） ],with a stable result [bias_p = 0. 248,bias_95 CI =（- 15. 77378,4. 808581） ]; Recurrence rate did not change significantly [P = 0. 983,I2= 0,RR = 1. 27,95% CI =（ 0. 44,3. 68）for 3- year follow- up; P = 0. 983,I2= 0%,RR = 1. 18,95% CI =（ 0. 44,3. 17） for 5- year follow- up],with a stable result [bias_p = 0. 317,bias_95 CI =（- 0. 2657797,1. 462447） for 3- year follow- up,bias_ p = 0. 234,bias_95 CI =（- 5. 125295,11. 72263） for 5- year follow- up. Conclusion Breast- conserving surgery can reduce the operation time and blood loss significantly in breast cancer patients,which is worthy of promotion in clinical practice.

关 键 词：乳腺癌 保乳术 改良根治术 系统评价 

分 类 号：R737.9[医药卫生—肿瘤]