Department of Breast Surgery, Kingston Hospital, Galsworthy Road, Kingston-upon-Thames, Surrey KT2 7QB, UK.
Eur J Surg Oncol. 2012 Oct;38(10):897-901. doi: 10.1016/j.ejso.2012.05.006. Epub 2012 Jun 14.
Electrocautery has advanced the practice of mastectomy but significant morbidity, such as seroma and blood loss, remains a concern. This has led to newer forms of dissection being introduced including the ultrasonic dissection devices, which are thought to reduce tissue damage. The aim of this systematic review was to compare the outcomes after mastectomy using novel ultrasonic dissection or standard electrocautery in published trials.
Medline, Embase, trial registries, conference proceedings and reference lists were searched for comparative trials of ultrasonic dissection versus electrocautery for mastectomy. The primary outcomes were total postoperative drainage, seroma development and intra-operative blood loss. Secondary outcomes were operative time and wound complications. Odds ratios were calculated for categorical outcomes and standardised mean differences for continuous outcomes.
Six trials were included in the analysis of 287 mastectomies. There was no effect in total postoperative drainage (pooled analysis weight mean difference: -0.21 (95% CI: -0.70-0.29); p = 0.41) or seroma development (pooled analysis odds ratio: 0.77 (95% CIs 0.43-1.37); p = 0.37). Intra-operative blood was slightly less for ultrasonic dissection compared to standard electrocautery (pooled analysis weight mean difference: -1.04 (95% CI: -2.00 to -0.08); p = 0.03). Ultrasonic dissection and standard electrocautery had similar outcomes with regard to operative time and wound complications.
Ultrasonic dissection and standard electrocautery appear to deliver similar results in the mastectomy setting. Further cost-effectiveness analysis may guide surgeon selection in the use of new technologies for mastectomy.
电灼在乳腺癌手术中已经得到了广泛应用，但仍存在一些显著的并发症，如血清肿和失血等，这仍是一个关注点。这导致了一些新的解剖方式的出现，包括超声切割设备，它被认为可以减少组织损伤。本系统评价的目的是比较在已发表的试验中，使用新型超声切割或标准电灼在乳腺癌手术后的结果。
通过 Medline、Embase、试验注册处、会议记录和参考文献搜索了比较超声切割与电灼用于乳腺癌手术的对照试验。主要结局是总术后引流、血清肿形成和术中失血。次要结局是手术时间和伤口并发症。对于分类结局，计算了比值比，对于连续结局，计算了标准化均数差。
有 6 项试验被纳入了 287 例乳腺癌手术的分析。在总术后引流方面没有效果（合并分析加权均数差：-0.21（95%CI：-0.70-0.29）；p=0.41）或血清肿形成（合并分析比值比：0.77（95%CI 0.43-1.37）；p=0.37）。与标准电灼相比，超声切割术中失血略少（合并分析加权均数差：-1.04（95%CI：-2.00 至-0.08）；p=0.03）。超声切割和标准电灼在手术时间和伤口并发症方面的结果相似。
在乳腺癌手术中，超声切割和标准电灼似乎产生了相似的结果。进一步的成本效益分析可能会指导外科医生在使用新技术进行乳腺癌手术时的选择。
