延迟自体乳房重建术对上肢淋巴水肿治疗效果的系统评价

目的 系统评价延迟自体乳房重建术治疗上肢淋巴水肿的效果。方法 检索Cochrane Library、PubMed、Embase、Scopus、Web of Science数据库,搜集关于延迟自体乳房重建术对上肢淋巴水肿治疗效果的研究,检索时间为建库至2020年6月。由2名研究员独立筛选符合标准的文献并进行数据提取,采用澳大利亚JBI循证卫生保健中心的文献质量评价工具对纳入文献质量进行评价,采用RevMan 5.3软件进行Meta分析。结果 纳入11篇文献,其中6篇纳入定量合成分析,Meta分析结果显示,64.8%（95%CI,0.32~0.88）的患者无论是否接受淋巴结移植,进行乳房重建术后淋巴水肿均有所改善。亚组分析结果显示,84.4%（95%CI,0.72~0.92）的患者在接受乳房重建术和淋巴结移植后淋巴水肿有所改善,而仅有21.9%（95%CI,0.14~0.33）的患者在只接受乳房重建术后淋巴水肿有所改善。结论 延迟自体乳房重建术可以改善乳腺癌患者术后上肢淋巴水肿,其中淋巴结移植可能是促进淋巴水肿改善的因素。

Effect of Delayed Autologous Breast Reconstruction on Patients with Upper Extremity Lymphedema:A systematic Review

Objective To systematically evaluate the effect of delayed autologous breast reconstruction in the treatment of upper limb lymphedema.Methods The databases of Cochrane Library,PubMed,Embase,Scopus and Web of Science were searched to collect studies on therapeutic effect of delayed autologous breast reconstruction on upper limb lymphedema from the inception to June 2020.The eligible articles were independently screened by two researchers and the data were extracted.The quality of the included literature was evaluated by the literature quality evaluation tool of the JBI,and the RevMan5.3 software was used for Meta analysis.Results Eleven articles were included,of which six were quantitative synthetic analysis.Meta analysis showed that 64.8%(95%confidence interval,0.32~0.88)of the patients reduced lymphedema after breast reconstruction whether they received lymph node transplantation or not.Subgroup analysis showed that 84.4%(95%confidence interval,0.72~0.92)of patients reduced lymphedema after breast reconstruction and lymph node transplantation,while only 21.9%(95%confidence interval,0.14~0.33)reduced lymphedema after breast reconstruction.Conclusion Delayed autologous breast reconstruction can improve upper limb lymphedema in patients with breast cancer,and lymph node transplantation may be the largest contributing factor leading to lymphedema improvement.