Liechti Rémy, van de Wall Bryan J M, Hug Urs, Fritsche Elmar, Franchi Alberto
From the Departments of Hand and Plastic Surgery.
Orthopedic and Trauma Surgery, Cantonal Hospital of Lucerne.
Plast Reconstr Surg. 2023 May 1;151(5):949-957. doi: 10.1097/PRS.0000000000010071. Epub 2022 Dec 19.
The perioperative use of tranexamic acid (TXA) has become popular among plastic surgeons for a variety of surgical procedures. The aim of this study was to perform a systematic review and meta-analysis on the results reported in the literature regarding the effect of perioperative systemic TXA administration in breast surgery.
The PubMed, MEDLINE, Embase, CENTRAL, and CINAHL databases were searched for both randomized clinical trials and observational studies. Effect estimates were pooled across studies using random effects models and presented as weighted odds ratio with corresponding 95% confidence interval.
A total of five studies encompassing 1139 patients undergoing mastectomy with or without immediate implant or free flap-based breast reconstruction or breast-conserving surgery with or without axillary lymph node dissection were included. Perioperative intravenous administration of TXA significantly reduced the risk for hematoma (7.3% versus 12.9%; OR, 0.43; 95% CI, 0.23 to 0.81) and seroma formation (11.5% versus 19.9%; OR, 0.57; 95% CI, 0.35 to 0.92) in comparison to the control group. In the studies measuring the postoperative drainage amount, the mean difference was 132 mL (95% CI, 220 to 44 mL). No thromboembolic event occurred in either group. The weighted surgical-site infection rate was higher in the control group (3.1% versus 1.5%). However, these data were too sparse to perform comparative meta-analysis.
Evidence of this study suggests that perioperative administration of TXA significantly reduces the risk for postoperative hematoma and seroma formation in breast surgery, whereas the risk for thromboembolic events and postoperative infection is not increased.
氨甲环酸（TXA）在围手术期的应用在整形外科医生中因各种外科手术而变得流行。本研究的目的是对文献报道的围手术期全身应用TXA在乳腺手术中的效果进行系统评价和荟萃分析。
检索了PubMed、MEDLINE、Embase、CENTRAL和CINAHL数据库，以查找随机临床试验和观察性研究。使用随机效应模型对各研究的效应估计值进行汇总，并以加权比值比及其相应的95%置信区间表示。
共纳入五项研究，包括1139例行乳房切除术的患者，这些患者接受或未接受即刻植入或游离皮瓣乳房重建，或保乳手术，伴或不伴腋窝淋巴结清扫。与对照组相比，围手术期静脉注射TXA显著降低了血肿风险（7.3%对12.9%；比值比，0.43；95%置信区间，0.23至0.81）和血清肿形成风险（11.5%对19.9%；比值比，0.57；95%置信区间，0.35至0.92）。在测量术后引流量的研究中，平均差异为132 mL（95%置信区间，220至44 mL）。两组均未发生血栓栓塞事件。对照组的加权手术部位感染率较高（3.1%对1.5%）。然而，这些数据过于稀少，无法进行比较荟萃分析。
本研究证据表明，围手术期应用TXA可显著降低乳腺手术术后血肿和血清肿形成的风险，而血栓栓塞事件和术后感染风险并未增加。
