背景:皮瓣神经痛是一种有希望的解决方案,可以恢复乳房切除术后感觉的减弱或完全丧失。这项系统评价比较了神经化和非神经化腹部自体乳房重建的感觉结果,以确定其在常规临床实践中的益处。
方法:根据PRISMA指南进行文献检索。Medline,PubMed,EMBASE,并查询Cochrane数据库进行相关研究。压力灵敏度,使用Semmes-Weinstein单丝(SWM)或压力指定传感装置(PSSD)测量,是主要结果指标。
结果:共纳入12项研究,包括367个神经化和295个非神经化皮瓣重建。其中8项研究纳入荟萃分析。神经皮瓣表现出优于非神经皮瓣的感觉结果,SWM得分存在显著差异(平均差[MD],随访时-1.55295%CI,-2.351至-0.7535;p=0.0001)和PSSD(MD-13.36;95%CI,-26.41至-0.3117;p=0.0448)(范围8至77个月)。SWM组(p=0.0010)的总皮肤感觉(天然和皮瓣皮肤组合)差异具有统计学意义,而PSSD组(p=0.0649)则无统计学意义。对影响神经化皮瓣感觉恢复的因素的研究结果尚无定论。
结论:与非神经皮瓣相比,神经皮瓣始终表现出更好的感觉结果,无论皮瓣类型或神经技术。然而,进一步的研究对于阐明影响感觉恢复的因素和标准化神经治疗实践以实现更优的乳房切除术后重建结果至关重要.
BACKGROUND: Flap neurotisation is a promising solution to restore the diminished or complete loss of sensation following mastectomy. This systematic review compared sensory outcomes in neurotised versus non-neurotised abdominal-based autologous breast reconstructions to establish its benefit in routine clinical practice.
METHODS: A literature search was performed according to the PRISMA guidelines. Medline, PubMed, EMBASE, and Cochrane databases were queried for relevant studies. Pressure sensitivity, measured using Semmes-Weinstein monofilaments (SWM) or the pressure-specified sensory device (PSSD), was the primary outcome measure.
RESULTS: A total of 12 studies comprising 367 neurotised and 295 non-neurotised flap reconstructions were included, with 8 studies included in the meta-analysis. Neurotised flaps demonstrated superior sensory outcomes over non-neurotised flaps, with significant differences in SWM scores (mean difference [MD], -1.552 95% CI, -2.351 to -0.7535; p = 0.0001) and PSSD (MD -13.36; 95% CI, -26.41 to -0.3117; p = 0.0448) at follow-up (range 8 to 77 months). The differences in total skin sensation (native and flap skin combined) were statistically significant in the SWM group (p = 0.0010) but not in the PSSD group (p = 0.0649). Investigation on the factors impacting sensation recovery in neurotised flaps yielded inconclusive outcomes.
CONCLUSIONS: Neurotised flaps consistently demonstrated superior sensation outcomes compared with non-neurotised flaps, irrespective of flap type or neurotisation technique. However, further research is essential to elucidate the factors that impact sensory recovery and standardise neurotisation practices for more optimal post-mastectomy reconstruction outcomes.