保留少量腹直肌的游离TRAM皮瓣和DIEP皮瓣乳房再造并发症的Meta分析-东南大学学报医学版

保留少量腹直肌的游离TRAM皮瓣和DIEP皮瓣乳房再造并发症的Meta分析

作者：杨明谭谦

单位：1. 东南大学医学院江苏南京 210009;2. 南京大学医学院附属鼓楼医院整形烧伤科, 江苏南京 210008

关键词：保留少量腹直肌的游离TRAM皮瓣腹壁下动脉穿支皮瓣乳房再造并发症 Meta分析

分类号：R622

出版年·卷·期（页码）：2012·31·第六期（711-720）

摘要：

目的:比较保留少量腹直肌的游离TRAM皮瓣(MS-Free TRAM)和腹壁下动脉穿支皮瓣(DIEP)乳房再造术的并发症发生率,为临床决策提供依据。方法:在Medline数据库、中国生物医学数据库、维普生物数据库、Cochrane图书馆等检索有关MS-Free TRAM及DIEP乳房再造的文献。按照纳入与排除标准选择文献、提取资料和评价质量后,采用RevMan5.0和R2.15软件进行Meta分析。结果:同时包含MS-Free TRAM和DIEP的研究有7个;MS-Free TRAM和DIEP发生脂肪液化OR值为0.69,95%CI为[0.26,1.78],P=0.44;发生皮瓣部分坏死OR值为0.92,95%CI为[0.38,2.23],P=0.86;发生皮瓣完全坏死OR值为0.35,95%CI为[0.13,0.90],P=0.03;发生腹壁膨隆或疝OR值为2.07,95%CI为[1.15,3.73],P=0.01。结论: 与MS-Free TRAM乳房再造相比,DIEP乳房再造的腹壁并发症发生率较低,但皮瓣完全坏死的风险是增加的。

Objective: To analyze the complications of breast reconstruction with muscle-sparing free transverse rectus abdominis myocutaneous flap(MS-Free TRAM) and deep inferior epigastric perforator flap(DIEP). Methods: Databases such as Medline, CBM, VIP and Cochrane Library were searched to include articles on breast reconstruction with MS-Free TRAM and DIEP flap. Meta analyses were performed by RevMan 5.0 and R 2.15 software after the data were abstracted and the quality was evaluated. Results: Seven studies reporting outcomes of MS-Free TRAM and DIEP flap were used to estimate odds ratios of complications and confidence intervals. MS-Free TRAM group and DIEP group occurred the risk of fat necrosis combined OR=0.69, 95%CI was[0.26,1.78], P=0.44, occurred the risk of partial flap loss combined OR=0.92, 95%CI was[0.38,2.23], P=0.86, occurred the risk of total flap loss combined OR=0.35,95%CI was[0.13,0.90],P=0.03, occurred the risk of abdominal bulge or hernia combined OR=2.07,95%CI was[1.15,3.73],P=0.01. Conclusions: Compared with the MS-Free TRAM flap, reduces abdominal morbidity of breast reconstruction with DIEP flap is lower but the risk of total flap loss is increased.

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