补片联合假体即刻乳房再造术后并发症的系统综述  

A systematic review on postoperative complications of implant-based breast reconstruction with biological and synthetic meshes

作　　者：胡访溪 陈璐 孙文全 Hu Fangxi;Chen Lu;Wendell Q.Sun(Institute of Biothermal Science and Technology,School of Health Science and Engineering,University of Shanghai for Science and Technology,Shanghai 200093,China)

机构地区：[1]上海理工大学健康科学与工程学院生物系统热科学研究所,上海200093

出　　处：《中华整形外科杂志》2022年第6期701-707,共7页Chinese Journal of Plastic Surgery

摘　　要：近年,随着乳腺癌的发病率逐年攀升和生物材料科学的快速发展,多种补片在乳腺癌术后的乳房再造中得到了广泛应用,使用补片可降低手术难度、简化流程和提升再造乳房的美感。该文系统检索了8个国内外医学研究数据库中关于补片联合假体行即刻乳房再造术后并发症种类和发生率的文献,将符合文献筛选标准的2005至2021年发表的86篇研究论文的结果做了系统综述,分析了17798例补片联合假体即刻乳房再造术后12个月及以上的术后并发症种类、总并发症发生率和严重并发症发生率,以及使用生物补片与合成补片之间并发症发生率的差异。统计结果表明,补片联合假体即刻乳房再造术后总并发症发生率为30.1%,严重并发症发生率为11.0%。最为常见的严重并发症是假体外露与取出、皮瓣坏死与创口不愈、术后感染、血清肿与血肿,这几种并发症占严重并发症的75%以上。使用生物补片和合成补片的术后严重并发症类别的构成比例存在差异,使用生物补片术后出现皮瓣坏死、乳房不对称和畸形的比例较高;而使用合成补片术后出现假体外露与取出的比例较高。手术医师除了要关注不同补片的选择,还应关注手术方式和术后并发症的预防和控制措施。Over the past decades,due to the increasing incidence of breast cancers and the rapid advances achieved in biomaterials science,a variety of biological and synthetic meshes have been developed for implant-based breast reconstruction immediately after mastectomy.The mesh-based procedure of breast reconstruction simplifies surgical procedures,reduces postoperative complications,and improves the aesthetic outcomes.We have systematically searched 8 medical literature databases on the complications of breast reconstruction immediately after mastectomy with the use of biological or synthetic meshes in support of prosthetic implants or tissue expanders.This review included a total of 86 clinical studies that met the screening criteria and were published from 2005 to 2021.We reviewed the incidences of major and overall postoperative complications over 12 months or longer in a total of 17798 breast reconstructions,which were over 10% and 30%,respectively.Major postoperative complications included implant exposure and extraction,dehiscence and skin necrosis,infection,hematoma and seroma,which account for more than 75%of all major postoperative adverse events.There were considerable differences in the incidences of major postoperative complications between biological meshes and synthetic meshes.The use of biological meshes is associated with higher rates of dehiscence and skin necrosis,whereas the use of synthetic meshes is associated with higher rates of implant exposure and extraction.Therefore,besides the selection of proper meshes,surgeons are expected to pay more attention to the prevention and treatment of major complications.

关 键 词：乳腺肿瘤 乳房再造 生物补片 合成补片 手术后并发症 

分 类 号：R737.9[医药卫生—肿瘤]