保留乳头乳晕的改良根治术和重建荟萃分析  

Modified radical mastectomy with reserving nipple-areola complex and immediate breast reconstruction: a meta-analysis

作　　者：陈秀[1] 李建[1] 周思颖[2] 唐金海[3] 

机构地区：[1]南京医科大学附属肿瘤医院普外科,江苏南京210009 [2]南京中医药大学第一临床医学院,江苏210046 [3]南京医科大学附属第一医院普外科,江苏南京210029

出　　处：《中国肿瘤外科杂志》2016年第3期151-157,共7页Chinese Journal of Surgical Oncology

摘　　要：目的探讨保留乳头乳晕复合体的乳腺切除及乳房即刻重建手术在中国的临床应用情况,以及对预后的影响。方法检索Pub Med、中国知网、维普、万方数据库中关于保留乳头乳晕复合体和乳房重建相关的文献,没有时间和语言限制。对符合入选标准的文献进行质量评价与荟萃分析。结果共有16篇随机对照试验纳入分析。11篇研究分析得出乳腺癌改良根治术后进行Ⅰ期重建术增加了术后并发症,但差异没有统计学意义(P=0.106),4篇文献分析结果显示保留乳头乳晕复合体后增加了术后并发症(P=0.026)。5篇研究分析显示乳腺癌改良根治术后进行Ⅰ期重建术并没有增加局部复发的概率(P=0.735),3篇研究提示乳腺癌改良根治术后进行Ⅰ期重建术并没有增加远处转移的概率(P=0.905),3篇文献显示保留乳头乳晕复合体后增加了远处转移的概率,但差异没有统计学意义(P=0.523)。7篇研究证实乳腺癌改良根治术后进行Ⅰ期重建术加强了患者对外观的满意度(P=0.000)。结论保留乳头乳晕复合体的乳腺癌改良根治术+Ⅰ期重建术并不增加术后并发症、局部复发和远期转移的发生,却增强了术后满意度,可以作为早期年轻乳腺癌患者的首选术式。Objective This study was aimed to identify the clinical application and prognostic impact of the modified radical mastectomy with reserving nipple-areola complex and immediate breast reconstruction in China.Methods Pub Med,CNKI,VIP,Wanfang databases were searched for literatures concerning the modified radical mastectomy with reserving nipple-areola complex and immediate breast reconstruction. No limit was set on language or time. Then a meta-analysis was conducted in literatures meeting the inclusion criteria. Results A total of 16 randomized studies were included. 11 of them concluded that immediate breast reconstruction aggravated the postoperative complication,though without statistically significant differences（ P = 0. 106）. 4 studies illustrated that reserving nipple-areola complex evidently added to postoperative complication（ P = 0. 026）. No significant effect was observed on local recurrence（ P = 0. 735） in 5 studies and distant metastasis in 3 studies（ P = 0. 905）. 3 studies verified that reserving nipple-areola complex may cause distant metastasis,although without significant differences（ P = 0. 523）. 7 researches proved that modified radical mastectomy with reserving nipple-areola complex and immediate breast reconstruction led to significantly better satisfaction of breast cancer patients（ P = 0. 000）. Conclusion Modified radical mastectomy with reserving nipple-areola complex and immediate breast reconstruction could be the optimal choice of early breast cancer patients,which showed less complications,recurrences or metastasis,and better appearance.

关 键 词：乳腺癌 保留乳头乳晕 乳房重建 荟萃分析 

分 类 号：R737.9[医药卫生—肿瘤]