Yalanis Georgia C, Liu En-Wei, Cheng Hsu-Tang
Baltimore, Md.; and Taichung City, Taiwan From Johns Hopkins University, School of Medicine; and the Division of Plastic and Reconstructive Surgery, Department of Surgery, China Medical University Hospital, China Medical University School of Medicine.
Plast Reconstr Surg. 2015 Oct;136(4):687-698. doi: 10.1097/PRS.0000000000001576.
Capsular contracture is common and distressing after aesthetic breast augmentation. The precise cause of capsular contracture is not well established. This systematic review investigates current available evidence regarding perioperative povidone-iodine irrigation safety and efficacy in reducing capsular contracture.
PubMed/MEDLINE, Embase, and Scopus databases were searched for publications through December of 2014. Studies with the following criteria were included: (1) primary breast augmentation with implants; (2) perioperative povidone-iodine use; and (3) documentation of capsular contracture. Our primary outcome was incidence of Baker class III/IV capsular contracture. The methodologic quality of included studies was assessed independently. Trials were meta-analyzed to obtain a pooled odds ratio describing the effect of povidone-iodine irrigation on Baker class III/IV capsular contracture.
Nine studies with a total of 5153 patients undergoing aesthetic breast augmentation with implants were included. Only three comparative studies achieved high methodologic quality. The meta-analysis included four studies, with 1191 patients receiving povidone-iodine irrigation and 595 patients receiving saline irrigation. The meta-analysis favored povidone-iodine irrigation for decreasing Baker class III/IV capsular contracture (2.7 percent versus 8.9 percent; OR, 0.30; 95 percent CI, 0.18 to 0.50; p < 0.00001; I = 0 percent). The reported implant rupture rates for both saline implants and silicone implants were less than 1 percent.
Perioperative povidone-iodine irrigation reduces Baker class III/IV capsular contracture and is not associated with implant rupture. Low methodologic quality of included studies limits recommendations for perioperative povidone-iodine irrigation as the standard of practice. Additional high-quality trials are warranted to corroborate the findings of this meta-analysis.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
在美容隆乳术后，包膜挛缩很常见且令人苦恼。包膜挛缩的确切病因尚未完全明确。本系统评价旨在调查目前关于围手术期聚维酮碘冲洗在降低包膜挛缩方面的安全性和有效性的现有证据。
检索PubMed/MEDLINE、Embase和Scopus数据库，截至2014年12月的出版物。纳入符合以下标准的研究：（1）初次植入式隆乳术；（2）围手术期使用聚维酮碘；（3）有包膜挛缩的记录。我们的主要结局是贝克III/IV级包膜挛缩的发生率。对纳入研究的方法学质量进行独立评估。对试验进行荟萃分析，以获得描述聚维酮碘冲洗对贝克III/IV级包膜挛缩影响的合并比值比。
纳入了9项研究，共5153例接受植入式美容隆乳术的患者。只有3项比较研究达到了较高的方法学质量。荟萃分析纳入了4项研究，1191例患者接受聚维酮碘冲洗，595例患者接受生理盐水冲洗。荟萃分析支持聚维酮碘冲洗可降低贝克III/IV级包膜挛缩（2.7%对8.9%；比值比，0.30；95%可信区间，0.18至0.50；P<0.00001；I²=0%）。报道的生理盐水植入物和硅胶植入物的破裂率均低于1%。
围手术期聚维酮碘冲洗可降低贝克III/IV级包膜挛缩，且与植入物破裂无关。纳入研究的方法学质量较低，限制了将围手术期聚维酮碘冲洗作为标准做法的推荐。需要更多高质量试验来证实该荟萃分析的结果。
临床问题/证据级别：治疗性，II级
