背景:腋窝淋巴结清扫术(ALND)后的血清瘤形成仍然是一个麻烦的并发症,具有显著的发病率。许多研究试图确定预防血清肿形成的技术。本系统评价和网络荟萃分析的目的是利用现有文献确定独立ALND后预防血清肿的最佳干预措施。
方法:对过去25年中接受独立ALND或ALND保乳手术的患者血清肿形成的所有比较文章进行了文献检索。关于血清肿形成的数据,临床显著血清肿(CSS),手术部位感染(SSI),并收集血肿。使用随机效应模型进行网络荟萃分析,并使用Bucher方法评估不一致程度。
结果:共纳入19篇1962例患者的文章。描述了十种预防血清肿形成的不同技术。当结合直接和间接比较时,腋窝引流,直到连续两天每24小时输出小于50ml,结果CSS显着减少。使用能量密封装置,填充,组织胶,或补丁并没有显着降低CSS的发生率。当比较关于SSI的不同技术时,没有观察到有统计学意义的差异。
结论:为了防止ALND后的CSS,腋窝引流是最有价值和科学证明的措施。根据网络荟萃分析的系统评价结果,当输出<50毫升每24小时连续两天,无论持续时间如何,移除引流似乎是最好的。由于排水政策差异很大,需要一个循证指南.
BACKGROUND: Seroma formation after axillary lymph node dissection (ALND) remains a troublesome complication with significant morbidity. Numerous studies have tried to identify techniques to prevent
seroma formation. The aim of this systematic review and network meta-analysis is to use available literature to identify the best intervention for prevention of seroma after standalone ALND.
METHODS: A literature search was performed for all comparative articles regarding seroma formation in patients undergoing a standalone ALND or ALND with breast-conserving surgery in the last 25 years. Data regarding
seroma formation, clinically significant
seroma (CSS), surgical site infections (SSI), and hematomas were collected. The network meta-analysis was performed using a random effects model and the level of inconsistency was evaluated using the Bucher method.
RESULTS: A total of 19 articles with 1962 patients were included. Ten different techniques to prevent
seroma formation were described. When combining direct and indirect comparisons, axillary drainage until output is less than 50 ml per 24 h for two consecutive days results in significantly less CSS. The use of energy sealing devices, padding, tissue glue, or patches did not significantly reduce the incidence of CSS. When comparing the different techniques with regard to SSIs, no statistically significant differences were seen.
CONCLUSIONS: To prevent CSS after ALND, axillary drainage is the most valuable and scientifically proven measure. On the basis of the results of this systematic review with network meta-analysis, removing the drain when output is < 50 ml per 24 h for two consecutive days irrespective of duration seems best. Since drainage policies vary widely, an evidence-based
guideline is needed.