乳腺癌是全球最常见的恶性肿瘤,乳房切除术仍然是治疗早期乳腺癌的主要策略。然而,并发症发生率,手术变量,微创保留乳头乳房切除术(MINSM)的肿瘤学安全性尚未得到充分解决.我们系统地搜索了PubMed,WebofScience,Embase,和Cochrane图书馆进行随机对照试验(RCTs)和非RCTs,将MINSM与常规保留乳头的乳房切除术(CNSM)进行比较,其次是假体乳房重建(PBR)。观察到的主要结果包括总体并发症,(III级)并发症,皮肤和乳头坏死,伤口裂开,感染,血清肿,血肿,植入物损失,和肿瘤安全性(阳性切缘和复发)。次要结果包括手术时间,失血,住院,成本效益,患者满意度。使用比值比(OR)和平均差(MD)以及95%置信区间(CI)比较二元变量和连续变量。共纳入10项研究,涉及2,166名患者。MINSM和CNSM在皮肤坏死方面无统计学差异,伤口裂开,感染,血清肿,血肿,植入物损失,或肿瘤安全。然而,MINSM显著削减整体并发症(OR=0。74,95%CI[0。58,0。94],p=0。01)和(Ⅲ级)并发症(OR=0。47,95%CI[0。31,0。71],p=0。0003).MINSM组乳头坏死事件也显著减少(OR=0。49,95%CI[0。30,0。80],p=0。005)。MINSM组患者满意度显著提高。此外,与CNSM组相比,MINSM组手术时间较长(MD=46.88,95%CI[19。55、74。21],p=0。0008)和住院时间(MD=1。39,95%CI[0。65,2。12],p<0。001),而术中失血量明显减少(MD=-29。05,95%CI[-36。20,-21。90],p<0。001).与CNSM相比,MINSM在减少并发症和术中失血方面具有优势,以及改善美学结果和患者满意度。因此,MINSM可能成为乳房手术的可行选择。然而,有必要对这种方法的肿瘤安全性进行长期评估,以确保其对患者的有效性和安全性.
Breast cancer is the most common malignant tumor worldwide, and mastectomy remains the primary strategy for treating early stage breast cancer. However, the complication rates, surgical variables, and oncologic safety of minimally invasive nipple-sparing mastectomy (MINSM) have not been fully addressed. We systematically searched PubMed, Web of Science, Embase, and the Cochrane Library for randomized-controlled trials (RCTs) and non-RCTs that compared MINSM with conventional nipple-sparing mastectomy (CNSM), both followed by Prosthesis Breast Reconstruction (PBR). The main outcomes observed included overall complications, (Grade III) complications, skin and nipple necrosis, wound dehiscence, infection, seroma, hematoma, implant loss, and oncologic safety (positive margins and recurrence). Secondary outcomes included operation time, blood loss, hospital stay, cost-effectiveness, and patient satisfaction. Binary and continuous variables were compared using odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI). A total of 10 studies involving 2,166 patients were included. There were no statistically significant differences between MINSM and CNSM in terms of skin necrosis, wound dehiscence, infection, seroma, hematoma, implant loss, or oncologic safety. However, MINSM significantly reduced overall complications (OR = 0. 74, 95% CI [0. 58, 0. 94], p = 0. 01) and (Grade III) complications (OR = 0. 47, 95% CI [0. 31, 0. 71], p = 0. 0003). Nipple necrosis events were also significantly reduced in the MINSM group (OR = 0. 49, 95% CI [0. 30, 0. 80], p = 0. 005). Patient satisfaction improved notably in the MINSM group. Additionally, compared with the CNSM group, the MINSM group had longer operating times (MD = 46. 88, 95% CI [19. 55, 74. 21], p = 0. 0008) and hospital stays (MD = 1. 39, 95% CI [0. 65, 2. 12], p < 0. 001), while intraoperative blood loss was significantly reduced (MD = -29. 05, 95% CI [-36. 20, -21. 90], p < 0. 001). Compared with CNSM, MINSM offers advantages in reducing complications and intraoperative blood loss, as well as improving aesthetic outcomes and patient satisfaction. Therefore, MINSM may become a viable option for breast surgery. Nevertheless, a long-term evaluation of the oncologic safety of this approach is necessary to ensure its efficacy and safety for patients.