Janis Jeffrey E, Khansa Lara, Khansa Ibrahim
Columbus, Ohio; and Blacksburg, Va.
From the Department of Plastic Surgery, The Ohio State University Wexner Medical Center; and the Department of Business Information Technology, Pamplin College of Business, Virginia Tech.
Plast Reconstr Surg. 2016 Jul;138(1):240-252. doi: 10.1097/PRS.0000000000002245.
There is conflicting evidence on the effectiveness of the various strategies to prevent postoperative seroma. Many high-quality studies have been performed to evaluate those strategies, but the numbers of patients included in those studies have been small. The authors' goal was to perform a systematic review of all Level I and II studies on the prevention of postoperative seroma.
A PubMed search was performed of all Level I and II studies that evaluated strategies for the prevention of postoperative seroma. Only English-language comparative studies on humans, defining seroma as a postoperative serous fluid collection detectable on physical examination, were included. Data from all the studies were compiled, and a systematic review was performed to evaluate the effectiveness of each strategy.
Seventy-five studies comprising 7173 patients were included. Effective strategies for seroma prevention included the use of closed-suction drains; keeping the drains until their output volume was minimal; maintaining a high pressure gradient in the drains; using sharp or ultrasonic dissection rather than cautery; dissecting the abdomen in a place superficial to the Scarpa fascia; ligating blood vessels with sutures or clips; using quilting or progressive tension sutures; using fibrin, thrombin, or talc; and immobilizing the surgical site postoperatively. Surgical-site compression did not prevent seroma accumulation. The use of sclerosants at the initial operation actually increased the risk of seroma.
Seroma is a common and frustrating complication in plastic surgery. This study demonstrates that simple strategies can be used to lower the risk of seroma.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
关于预防术后血清肿的各种策略的有效性，证据存在冲突。已经开展了许多高质量研究来评估这些策略，但这些研究纳入的患者数量较少。作者的目标是对所有关于预防术后血清肿的I级和II级研究进行系统评价。
对所有评估预防术后血清肿策略的I级和II级研究进行PubMed检索。仅纳入关于人类的英文比较研究，将血清肿定义为体格检查可检测到的术后浆液性积液。汇总所有研究的数据，并进行系统评价以评估每种策略的有效性。
纳入了75项研究，共7173例患者。预防血清肿的有效策略包括使用闭式吸引引流管；保留引流管直至引流量最小；保持引流管内的高压力梯度；使用锐性或超声分离而非电灼；在Scarpa筋膜浅层进行腹部解剖；用缝线或夹子结扎血管；使用褥式或渐进性张力缝线；使用纤维蛋白、凝血酶或滑石粉；以及术后固定手术部位。手术部位压迫并不能预防血清肿积聚。初次手术时使用硬化剂实际上增加了血清肿的风险。
血清肿是整形外科中常见且令人困扰的并发症。本研究表明，可采用简单策略降低血清肿风险。
临床问题/证据级别：治疗性，II级。
