Hamilton, Ontario, Canada; and Warsaw, Poland From the Department of Clinical Epidemiology and Biostatistics, the Division of Plastic Surgery, Department of Surgery, and the Surgical Outcomes Research Center, Department of Surgery, McMaster University; Programs for Assessment of Technology in Health Research Institute, St. Joseph's Healthcare Hamilton; and the Second Department of General, Vascular, and Oncologic Surgery, Medical University of Warsaw.
Plast Reconstr Surg. 2014 Feb;133(2):234-249. doi: 10.1097/01.prs.0000436847.94408.11.
Breast reconstruction after mastectomy for breast cancer should be informed by evidence-based knowledge, such as complication rates. The authors compared the safety of tissue expander/implant reconstruction with that of autologous abdominal tissue reconstruction.
A systematic literature review identified peer-reviewed studies published from January of 2000 to October of 2012 that compared tissue expander/implant against autologous abdominal tissue reconstruction in the MEDLINE, EMBASE, Cochrane Library, PubMed, and ProQuest Dissertations and Theses databases. Two reviewers independently screened all reports and selected the relevant articles using specific inclusion criteria. Data were extracted from the relevant articles using a standardized abstraction form.
Fourteen observational studies were identified that included more than 3000 reconstructed breasts. Significant differences were found between these two approaches. The relative risk associated with reconstructive failure favored autologous abdominal tissue (relative risk, 0.14; 95 percent CI, 0.06 to 0.32; I = 0 percent). Surgical-site infection was significantly lower in autologous abdominal tissue reconstruction compared with tissue expander/implant (relative risk, 0.37; 95 percent CI, 0.25 to 0.55; I = 0 percent), although skin or flap necrosis was higher in autologous abdominal tissue reconstruction compared with tissue expander/implant (relative risk, 2.79; 95 percent CI, 1.87 to 4.17). Studies were of low to moderate quality according to the Newcastle-Ottawa scale.
This study suggests that tissue expander/implant reconstruction has a higher risk of reconstructive failure and surgical-site infection compared with autologous abdominal tissue reconstruction. With the lack of long-term safety studies on different approaches to breast reconstruction, additional long-term comparative studies are needed to support evidence-based decision-making.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
乳腺癌乳房切除术后的乳房重建应该以循证知识为依据，如并发症发生率。作者比较了组织扩张器/植入物重建与自体腹部组织重建的安全性。
系统文献回顾确定了从 2000 年 1 月至 2012 年 10 月发表的同行评审研究，比较了组织扩张器/植入物与自体腹部组织重建在 MEDLINE、EMBASE、Cochrane 图书馆、PubMed 和 ProQuest Dissertations 和 Theses 数据库中的情况。两位评审员独立筛选所有报告，并使用特定的纳入标准选择相关文章。使用标准化的摘要表格从相关文章中提取数据。
确定了 14 项观察性研究，其中包括 3000 多个重建乳房。这两种方法之间存在显著差异。重建失败的相对风险有利于自体腹部组织（相对风险，0.14；95%置信区间，0.06 至 0.32；I = 0%）。与组织扩张器/植入物相比，自体腹部组织重建的手术部位感染显著降低（相对风险，0.37；95%置信区间，0.25 至 0.55；I = 0%），尽管自体腹部组织重建的皮肤或皮瓣坏死发生率高于组织扩张器/植入物（相对风险，2.79；95%置信区间，1.87 至 4.17）。根据纽卡斯尔-渥太华量表，这些研究的质量为低至中。
本研究表明，与自体腹部组织重建相比，组织扩张器/植入物重建的重建失败和手术部位感染风险更高。由于对不同乳房重建方法的长期安全性研究缺乏，需要进行更多的长期比较研究，以支持循证决策。
临床问题/证据水平：治疗性，III 级。
