Parmeshwar Nisha, Mehta Shayna R, Piper Merisa
From the Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, CA.
Wright State University, School of Medicine, Fairborn, OH.
Ann Plast Surg. 2023 Nov 1;91(5):622-628. doi: 10.1097/SAP.0000000000003635. Epub 2023 Jul 5.
Topical and intravenous uses of tranexamic acid (TXA) have been shown to reduce bleeding and ecchymosis in various surgical fields. However, there is a lack of data evaluating the efficacy of TXA in breast surgery. This systematic review evaluates the impact of TXA on hematoma and seroma incidence in breast plastic surgery.
A systematic review of the literature was performed for all studies that evaluated the use of TXA in breast surgery including reduction mammoplasty, gynecomastia surgery, masculinizing chest surgery, or mastectomy. Outcomes of interest included rate of hematoma, seroma, and drain output.
Thirteen studies met the inclusion criteria with a total of 3297 breasts, of which 1656 were treated with any TXA, 745 with topical TXA, and 1641 were controls. There was a statistically significant decrease in hematoma formation seen in patients who received any form of TXA compared with control (odds ratio [OR], 0.37; P < 0.001), and a similar tendency toward decreased hematoma with topically treated TXA (OR, 0.42; P = 0.06). There was no significant difference in seroma formation with any TXA (OR, 0.84; P = 0.33) or topical TXA (OR, 0.91; P = 0.70). When stratified by surgery, there was a 75% decrease in the odds of hematoma formation with any TXA compared with the control for oncologic mastectomy (OR, 0.25; P = 0.003) and a 56% decrease in nononcologic breast surgery (OR, 0.44; P = 0.003).
This review suggests that TXA may significantly reduce hematoma formation in breast surgery and may also decrease seroma and drain output. Future high-quality prospective studies are required to evaluate the utility of topical and intravenous TXA in decreasing hematoma, seroma, and drain output in breast surgery patients.
已证实氨甲环酸（TXA）局部及静脉使用可减少各类外科手术中的出血和瘀斑。然而，缺乏评估TXA在乳腺手术中疗效的数据。本系统评价评估了TXA对乳房整形手术中血肿和血清肿发生率的影响。
对所有评估TXA在乳腺手术（包括缩乳术、男性乳房肥大症手术、男性化胸部手术或乳房切除术）中使用情况的研究进行文献系统评价。感兴趣的结局包括血肿、血清肿发生率及引流量。
13项研究符合纳入标准，共涉及3297例乳房，其中1656例接受了任何形式的TXA治疗，745例接受局部TXA治疗，1641例为对照组。与对照组相比，接受任何形式TXA治疗的患者血肿形成有统计学显著减少（比值比[OR]，0.37；P < 0.001），局部使用TXA治疗的患者血肿形成也有类似减少趋势（OR，0.42；P = 0.06）。任何形式TXA治疗（OR，0.84；P = 0.33）或局部TXA治疗（OR，0.91；P = 0.70）的患者血清肿形成无显著差异。按手术类型分层时，与对照组相比，任何形式TXA治疗的肿瘤性乳房切除术患者血肿形成几率降低75%（OR，0.25；P = 0.003），非肿瘤性乳腺手术患者降低56%（OR，0.44；P = 0.003）。
本评价表明TXA可能显著减少乳腺手术中的血肿形成，也可能减少血清肿和引流量。未来需要高质量的前瞻性研究来评估局部及静脉使用TXA在减少乳腺手术患者血肿、血清肿和引流量方面的效用。
