Hashemi Ammar S A, Hussein Sara M, Alshehab Zainab H, Al Qurashi Abdullah A, Kreutz-Rodrigues Lucas, Sharaf Basel A
From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, MN.
Department of Surgery, College of Medicine, King Faisal University, Alahsa, Saudi Arabia.
Plast Reconstr Surg Glob Open. 2025 Jan 16;13(1):e6442. doi: 10.1097/GOX.0000000000006442. eCollection 2025 Jan.
Postoperative fluid-related complications, such as hematoma and seroma formation, are common concerns in breast surgery, adversely affecting surgical outcomes and patient recovery. Topical tranexamic acid (TXA) has emerged as a promising intervention to minimize bleeding while reducing systemic adverse effects linked to intravenous administration. However, evidence on the efficacy of topical TXA in breast surgery remains sparse.
This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. English-language databases were searched through April 2024 to identify randomized controlled trials and cohort studies assessing the effects of topical TXA on postoperative outcomes in breast surgery, including hematoma, seroma, infection rates, and drain output/duration.
Six studies, encompassing 823 patients and 1477 breasts, were included. Subgroup meta-analysis demonstrated a statistically significant reduction in hematoma rates in patients who underwent mastectomy (risk ratio [RR] = 0.14; 95% confidence interval [CI], 0.03-0.78; = 0.02), but not in patients who underwent breast reduction (RR = 0.76; 95% CI, 0.08-7.08; = 0.24). No significant differences were found in overall hematoma rates (RR = 0.32; 95% CI, 0.08-1.195; = 0.09), seroma formation (RR = 1.22; 95% CI, 0.99-1.51; = 0.07), or infection rates (RR = 0.85; 95% CI, 0.46-1.56; = 0.59).
Topical TXA significantly reduced hematoma rates in patients who underwent mastectomy but showed no significant effect on other outcomes. Larger studies with standardized methodologies are required to fully establish the role of topical TXA in optimizing breast surgery outcomes.
术后与液体相关的并发症，如血肿和血清肿形成，是乳腺手术中常见的问题，会对手术结果和患者恢复产生不利影响。局部应用氨甲环酸（TXA）已成为一种有前景的干预措施，可减少出血，同时降低与静脉给药相关的全身不良反应。然而，关于局部应用TXA在乳腺手术中疗效的证据仍然稀少。
本系统评价遵循系统评价和Meta分析的首选报告项目指南。检索英文数据库至2024年4月，以识别评估局部应用TXA对乳腺手术术后结局影响的随机对照试验和队列研究，包括血肿、血清肿、感染率以及引流液量/持续时间。
纳入了6项研究，共823例患者和1477个乳房。亚组Meta分析显示，接受乳房切除术的患者血肿发生率有统计学显著降低（风险比[RR]=0.14；95%置信区间[CI]，0.03-0.78；P=0.02），但接受乳房缩小术的患者则无此现象（RR=0.76；95%CI，0.08-7.08；P=0.24）。总体血肿发生率（RR=0.32；95%CI，0.08-1.195；P=0.09）、血清肿形成（RR=1.22；95%CI，0.99-1.51；P=0.07）或感染率（RR=0.85；95%CI，0.46-1.56；P=0.59）均未发现显著差异。
局部应用TXA显著降低了接受乳房切除术患者的血肿发生率，但对其他结局无显著影响。需要采用标准化方法进行更大规模的研究，以全面确定局部应用TXA在优化乳腺手术结局中的作用。
