摘要：背景：对于接受过乳房增大术的患者，与未接受过乳房增大术的患者相比，乳房切除术和假体重建后的并发症是否存在差异仍存在争议。本系统评价旨在评估接受乳房切除术和假体重建的患者中，既往有乳房增大术史和无乳房增大术史患者的并发症发生率。方法：在 PROSPERO 注册的系统评价（CRD42020212160）中，检索了 MEDLINE、Embase、Cochrane Central Register of Controlled Trials、Web of Science 和 ClinicalTrials.gov 数据库中截至 2022 年 10 月 1 日的相关研究。使用 Cochrane 偏倚风险工具评估了研究偏倚风险。采用随机效应模型进行荟萃分析。结果：共纳入 34 项研究（17341 名患者）。乳房增大术史与更高的总并发症发生率相关（RR=1.45，95%CI=1.14-1.85，I²=72%，P=0.002），在使用盐水填充假体（RR=1.55，95%CI=1.12-2.15，I²=82%，P=0.009）和特定乳房重建技术（即刻重建，RR=1.55，95%CI=1.03-2.32，I²=80%，P=0.03）时更为明显。在感染、血肿/血清肿、包膜挛缩和假体移位方面，两组之间差异有统计学意义。结论：既往有乳房增大术史与乳房切除术和假体重建术后更高的并发症发生率相关，尤其在使用盐水填充假体和即刻重建时更为明显。关键词：乳房切除术；乳房增大术；假体重建；并发症；系统评价；荟萃分析。

Systematic Review and Meta-Analysis of Complications Following Mastectomy and Prosthetic Reconstruction in Patients With and Without Prior Breast Augmentation.

机构信息

Department of Plastic and Reconstructive Surgery, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK.

Department of Plastic and Reconstructive Surgery, Erasmus Medical Centre Rotterdam, Rotterdam, the Netherlands.

出版信息

Aesthet Surg J. 2021 Jun 14;41(7):NP763-NP770. doi: 10.1093/asj/sjab028.

DOI:10.1093/asj/sjab028

PMID:33480970

Abstract

BACKGROUND

There is limited evidence available in the literature with regard to the complication profile of mastectomy and immediate prosthetic reconstruction in augmented patients.

OBJECTIVES

The aim of this systematic review and meta-analysis was to compare postoperative complications between women with vs without prior augmentation undergoing skin- or nipple-sparing mastectomy and immediate prosthetic reconstruction.

METHODS

A systematic search was conducted in February 2020 for studies comparing women with vs without prior augmentation undergoing skin- or nipple-sparing mastectomy and immediate prosthetic reconstruction with documentation of postoperative complications. Outcomes analyzed included early, late, and overall complications. Pooled odds ratios (ORs) with 95% CIs were obtained through meta-analysis.

RESULTS

Our meta-analysis, which included 6 studies comparing 241 breasts with prior augmentation and 1441 without, demonstrated no significant difference between the 2 groups in rates of early (36.7% vs 24.8%: OR, 1.57; 95% CI, 0.94-2.64; P = 0.09), late (10.1% vs 19.9%: OR, 0.53; 95% CI, 0.06-4.89; P = 0.57), and overall complications (36.5% vs 31.2%: OR, 1.23; 95% CI, 0.76-2.00; P = 0.40). Subgroup analysis showed a significantly higher rate of hematoma formation in the augmented group (3.39% vs 2.15%: OR, 2.68; 95% CI, 1.00-7.16; P = 0.05), but no difference in rates of seroma, infection, mastectomy skin flap necrosis, and prosthesis loss.

CONCLUSIONS

Our meta-analysis suggests that prior augmentation does not significantly increase overall postoperative complications in women undergoing skin- or nipple-sparing mastectomy and immediate prosthetic reconstruction. However, the significantly higher rate of hematoma formation in augmented patients warrants further investigation and preoperative discussion.

摘要

背景

关于接受过乳房增大术的患者行乳房切除术和即刻假体重建的并发症情况，目前文献中仅有有限的证据。

目的

本系统回顾和荟萃分析的目的是比较有/无既往隆乳史的患者行保留皮肤或乳头的乳房切除术和即刻假体重建后的术后并发症。

方法

于 2020 年 2 月进行系统检索，以查找比较有/无既往隆乳史的患者行保留皮肤或乳头的乳房切除术和即刻假体重建并记录术后并发症的研究。分析的结局包括早期、晚期和总体并发症。通过荟萃分析获得汇总优势比（OR）及其 95%置信区间（CI）。

结果

我们的荟萃分析纳入了 6 项研究，共比较了 241 例有既往隆乳史的乳房和 1441 例无既往隆乳史的乳房，结果显示两组间早期（36.7% vs 24.8%：OR，1.57；95%CI，0.94-2.64；P = 0.09）、晚期（10.1% vs 19.9%：OR，0.53；95%CI，0.06-4.89；P = 0.57）和总体并发症（36.5% vs 31.2%：OR，1.23；95%CI，0.76-2.00；P = 0.40）发生率无显著差异。亚组分析显示，既往隆乳组的血肿形成发生率显著更高（3.39% vs 2.15%：OR，2.68；95%CI，1.00-7.16；P = 0.05），但血清肿、感染、乳房皮瓣坏死和假体丢失的发生率无差异。