医用生物蛋白胶在乳腺癌手术中应用的Meta分析
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摘要
背景:医用生物蛋白胶近年来在乳腺癌手术中得到广泛的应用,但多数文献纳入的病例数少,应用效果存在一定差异。目的:系统评价医用生物蛋白胶在乳腺癌手术中应用的效果。方法:计算机检索中国期刊网全文数据库(CNKI)、维普数据库、万方数据库2002年3月至2014年3月公开发表的关于在乳腺癌手术中医用生物蛋白胶应用的随机对照临床试验文献,对纳入的研究采用Rev Man 5.2统计学软件进行Meta分析。结果与结论:Meta分析共纳入11项研究,合计1 043例患者。结果显示,应用医用生物蛋白胶的实验组术后第1天引流量[WMD=-85.62,95%CI(-128.86,-42.39),P=0.000 1]及术后总引流管引流量[WMD=-167.27,95%CI(-210.05,-124.49),P<0.000 01]都显著少于对照组,实验组术后皮下积液率[OR=0.30,95%CI(0.21,0.44),P<0.000 01]优于对照组,两组比较差异有显著性意义。提示在乳腺癌根治手术采用医用生物蛋白胶后可显著减少引流液,乳腺癌术后皮下积液的发生率明显降低。
BACKGROUND: Fibrin glue has been widely used in breast surgery, but due to the limitation of cases, there are some differences in clinical effects. OBJECTIVE: To systemically review the clinical effect of fibrin glue in breast surgery. METHODS: We searched China Journal Full-text Database(CNKI), VIP database, Wanfang Database for clinical randomized controlled trials related to fibrin glue used in breast surgery published from March 2002 to March 2014. A Meta-analysis was done in included studies using Rev Man 5.2 statistical software. RESULTS AND CONCLUSION: A total of 11 studies, with 1 043 cases, were enrolled for the Meta-analysis. Meta-analysis showed that the postoperative 1-day drainage amount and total drainage amount were significantly lower in the fibrin glue group than the control group [WMD=-85.62, 95%CI(-128.86,-42.39), P=0.000 1; WMD=-167.27, 95%CI(-210.05,-124.49), P < 0.000 01]. In addition, the fibrin glue group was superior to the control group in the postoperative seroma rate [OR=0.30, 95%CI(0.21, 0.44), P < 0.000 01]. Application of fibrin glue in breast cancer surgery can significantly reduce postoperative drainage and seroma rate.
BACKGROUND: Fibrin glue has been widely used in breast surgery, but due to the limitation of cases, there are some differences in clinical effects. OBJECTIVE: To systemically review the clinical effect of fibrin glue in breast surgery. METHODS: We searched China Journal Full-text Database(CNKI), VIP database, Wanfang Database for clinical randomized controlled trials related to fibrin glue used in breast surgery published from March 2002 to March 2014. A Meta-analysis was done in included studies using Rev Man 5.2 statistical software. RESULTS AND CONCLUSION: A total of 11 studies, with 1 043 cases, were enrolled for the Meta-analysis. Meta-analysis showed that the postoperative 1-day drainage amount and total drainage amount were significantly lower in the fibrin glue group than the control group [WMD=-85.62, 95%CI(-128.86,-42.39), P=0.000 1; WMD=-167.27, 95%CI(-210.05,-124.49), P < 0.000 01]. In addition, the fibrin glue group was superior to the control group in the postoperative seroma rate [OR=0.30, 95%CI(0.21, 0.44), P < 0.000 01]. Application of fibrin glue in breast cancer surgery can significantly reduce postoperative drainage and seroma rate.
引文
[1]徐雅莉,孙强,单广良,等.中国女性乳腺癌发病相关危险因素:病例对照研究[J].协和医学杂志,2011,2(1):7-14.
[2]杨永久,李瑞平,胡振华.乳腺癌术后皮下积液的防治[J].中国普通外科杂志,2005,14(4):310-311.
[3]席春芳,高润芳,张亚芬.医用生物蛋白胶在乳腺癌术中的应用[J].山西职工医学院学报,2009,19(1):38-40.
[4]杨梅,桓灵芝,甘琪,等.乳腺癌改良根治术创面使用生物蛋白胶促进切口愈合的研究[J].护士进修杂志,2002,17(8):567-568.
[5]罗凤,吴凯南.生物蛋白胶在乳腺癌手术中的应用价值[J].重庆医学,2004,33(7):1028-1029.
[6]覃新干,陆云飞,黄源,等.医用生物蛋白胶对乳腺癌术后皮下积液的预防作用[J].中国现代药物应用,2008,2(19):85-86.
[7]欧阳忠,吴毅平.医用生物蛋白胶预防乳腺癌术后皮下积液效果观察[J].赣南医学院学报,2009,29(3):342-343.
[8]崔凤奎,王国华,彭晓晖.医用生物蛋白胶在防治乳腺癌术后皮下积液的临床分析[J].齐齐哈尔医学院学报,2010,31(6):873-874.
[9]庄春柳,张翠君,郑汉旗,等.医用生物蛋白胶在乳腺癌改良根治术中的临床应用[J].护理研究,2008,22(16):1458-1460.
[10]马金柱,梁卫,布日古德,等.医用生物蛋白胶在乳腺癌根治术中的应用[J].中国误诊学杂志,2004,4(11):1816-1817.
[11]孙可望,张静霞,姜蔚.医用生物蛋白胶在乳腺癌根治术中的应用价值[J].浙江实用医学,2002,7(6):326,339.
[12]周绍强,李刚,寸英丽,等.医用生物蛋白胶在乳腺癌手术中的应用[J].大理医学院学报,2001,10(4):42-43.
[13]杜大军,尚长海,丁小崇.医用生物蛋白胶在预防乳腺癌术后并发症中的应用价值[J].河南外科学杂志,2008,14(3):7-8.
[14]Albala DM,Lawson JH.Recent clinical and investigational applications of fibrin sealant in selected surgical specialties.J Am Coll Surg.2006;202(4):685-697.
[15]庞广兴,陈建庭,钟招明,等.椎体内注射医用生物蛋白胶对松质骨创面出血影响的实验研究[J].中国脊柱脊髓杂志,2009,19(5):372-375.
[16]Velada JL,Hollingsbee DA,Menzies AR.Reproducibility of the mechanical properties of Vivo stat system patient-derived fibrinsealant.Biomaterials.2002;(10):2249-2254.
[17]Dickneite G,Metzner H,Nicolay U.Prevention of suture hole bleeding using fibrin sealant:benefits of factorⅩⅩ.J Surg Res.2000;93(2):201-205.
[18]Spotnitz WD.Commercial fibrin sealants in surgical care.Am J Surg.2001;182(2 Suppl):8S-14S.
[19]Jackson MR.Fibrin sealants in surgical practice:an overview.Am J Surg.2001;182(2 Suppl):1S-7S.
[20]Davidson B R,Burnett S,Javed M S,et al.Experimental study of a novel fibrin sealant for achieving haemostasis following partial hepatectomy.Br J Surg.2000;87(6):790-795.
[21]张献义,刘宁清,吕鹏.医用生物蛋白胶在甲状腺手术中的应用[J].中华普通外科杂志,2004,19(8):511.
[22]李寅,何兆群.医用生物蛋白胶在甲状腺次全切除术中的应用[J].广东医学,2005,26(2):237-238.
[23]龚圣济,张彪,姜波健.医用生物蛋白胶在胆囊手术中的应用[J].上海第二医科大学学报,2004,25(1):99-100.
[24]陈日新,李立才,卢全权.医用胶在肾碎裂伤手术中的应用[J].湖南医学,1999,16(2):135.
[25]刘玉杰,林峰,张西峰.CT引导下经皮穿刺医用生物蛋白胶治疗神经根囊肿[J].中国医学影像学杂志,2000,8(3):190-192.
[26]Woodworth PA,Mc Boyle MF,Helmer SD.Seroma formation after breast cancer surgery:incidence and predicting factors.Am Surg.2000;(5):444-450.
[27]Medl M,Mayerhofer K,Peters EC.The application of fibrin glue after axillary lymphadenectomy in the surgical treatment of human breast cancer.Anticancer Res.1995,(6B):2843-2845.
[28]张爱民,王建华,侯俊明,等.乳腺癌术后皮下积液及皮瓣坏死的防治体会(附62例报告)[J].现代肿瘤医学.2009,17(2):251-253.
[2]杨永久,李瑞平,胡振华.乳腺癌术后皮下积液的防治[J].中国普通外科杂志,2005,14(4):310-311.
[3]席春芳,高润芳,张亚芬.医用生物蛋白胶在乳腺癌术中的应用[J].山西职工医学院学报,2009,19(1):38-40.
[4]杨梅,桓灵芝,甘琪,等.乳腺癌改良根治术创面使用生物蛋白胶促进切口愈合的研究[J].护士进修杂志,2002,17(8):567-568.
[5]罗凤,吴凯南.生物蛋白胶在乳腺癌手术中的应用价值[J].重庆医学,2004,33(7):1028-1029.
[6]覃新干,陆云飞,黄源,等.医用生物蛋白胶对乳腺癌术后皮下积液的预防作用[J].中国现代药物应用,2008,2(19):85-86.
[7]欧阳忠,吴毅平.医用生物蛋白胶预防乳腺癌术后皮下积液效果观察[J].赣南医学院学报,2009,29(3):342-343.
[8]崔凤奎,王国华,彭晓晖.医用生物蛋白胶在防治乳腺癌术后皮下积液的临床分析[J].齐齐哈尔医学院学报,2010,31(6):873-874.
[9]庄春柳,张翠君,郑汉旗,等.医用生物蛋白胶在乳腺癌改良根治术中的临床应用[J].护理研究,2008,22(16):1458-1460.
[10]马金柱,梁卫,布日古德,等.医用生物蛋白胶在乳腺癌根治术中的应用[J].中国误诊学杂志,2004,4(11):1816-1817.
[11]孙可望,张静霞,姜蔚.医用生物蛋白胶在乳腺癌根治术中的应用价值[J].浙江实用医学,2002,7(6):326,339.
[12]周绍强,李刚,寸英丽,等.医用生物蛋白胶在乳腺癌手术中的应用[J].大理医学院学报,2001,10(4):42-43.
[13]杜大军,尚长海,丁小崇.医用生物蛋白胶在预防乳腺癌术后并发症中的应用价值[J].河南外科学杂志,2008,14(3):7-8.
[14]Albala DM,Lawson JH.Recent clinical and investigational applications of fibrin sealant in selected surgical specialties.J Am Coll Surg.2006;202(4):685-697.
[15]庞广兴,陈建庭,钟招明,等.椎体内注射医用生物蛋白胶对松质骨创面出血影响的实验研究[J].中国脊柱脊髓杂志,2009,19(5):372-375.
[16]Velada JL,Hollingsbee DA,Menzies AR.Reproducibility of the mechanical properties of Vivo stat system patient-derived fibrinsealant.Biomaterials.2002;(10):2249-2254.
[17]Dickneite G,Metzner H,Nicolay U.Prevention of suture hole bleeding using fibrin sealant:benefits of factorⅩⅩ.J Surg Res.2000;93(2):201-205.
[18]Spotnitz WD.Commercial fibrin sealants in surgical care.Am J Surg.2001;182(2 Suppl):8S-14S.
[19]Jackson MR.Fibrin sealants in surgical practice:an overview.Am J Surg.2001;182(2 Suppl):1S-7S.
[20]Davidson B R,Burnett S,Javed M S,et al.Experimental study of a novel fibrin sealant for achieving haemostasis following partial hepatectomy.Br J Surg.2000;87(6):790-795.
[21]张献义,刘宁清,吕鹏.医用生物蛋白胶在甲状腺手术中的应用[J].中华普通外科杂志,2004,19(8):511.
[22]李寅,何兆群.医用生物蛋白胶在甲状腺次全切除术中的应用[J].广东医学,2005,26(2):237-238.
[23]龚圣济,张彪,姜波健.医用生物蛋白胶在胆囊手术中的应用[J].上海第二医科大学学报,2004,25(1):99-100.
[24]陈日新,李立才,卢全权.医用胶在肾碎裂伤手术中的应用[J].湖南医学,1999,16(2):135.
[25]刘玉杰,林峰,张西峰.CT引导下经皮穿刺医用生物蛋白胶治疗神经根囊肿[J].中国医学影像学杂志,2000,8(3):190-192.
[26]Woodworth PA,Mc Boyle MF,Helmer SD.Seroma formation after breast cancer surgery:incidence and predicting factors.Am Surg.2000;(5):444-450.
[27]Medl M,Mayerhofer K,Peters EC.The application of fibrin glue after axillary lymphadenectomy in the surgical treatment of human breast cancer.Anticancer Res.1995,(6B):2843-2845.
[28]张爱民,王建华,侯俊明,等.乳腺癌术后皮下积液及皮瓣坏死的防治体会(附62例报告)[J].现代肿瘤医学.2009,17(2):251-253.