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目的系统评价腋窝淋巴结清扫术治疗前哨淋巴结活检阴性乳腺癌的有效性和安全性。方法检索CNKI、PubMed、EMBASE、CBM从建库至2013年12月1日的文献资料,选择腋窝淋巴结清扫术和前哨淋巴结活检术治疗乳腺癌患者的试验,严格按照制订纳入和排除标准对纳入的研究进行筛选、资料提取、质量评价和结果分析。使用Revman 5.1软件,进行统计学分析(Meta-分析)。结果最终纳入10篇文献,患者共7731例。因纳入文献在研究类型、测量指标、随访时间以及统计学指标的差异较大,采用亚组分析,Meta分析同质研究,其余采用定性的描述性分析。本研究结果显示,在无病生存率、总体生存率、局部复发率、远处转移率方面,不同随访时间腋窝淋巴结清扫术与前哨淋巴结切除术间差异均无统计学意义。结论对于单发浸润性乳腺癌患者前哨淋巴结活检呈阴性时,可不必行腋窝淋巴结清扫术。目前尚需相关高质量随机对照试验和长期的随访进一步证实此系统评价的结论。
Objective To evaluate the effectiveness and safety of axillary lymph node dissection in the treatment of sentinel lymph node biopsy negative breast cancer. Methods The clinical data of CNKI, PubMed, EMBASE and CBM from the database to December 1, 2013 were retrieved. The patients who underwent axillary lymphadenectomy and sentinel lymph node biopsy for breast cancer were included in the study. Research screening, data extraction, quality evaluation and results analysis. Statistical analysis (Meta-analysis) was performed using Revman 5.1 software. Results The final inclusion of 10 articles, a total of 7731 patients. Due to the inclusion of literature in the type of study, measurement, follow-up time and statistical indicators of the larger subgroup analysis, meta-analysis homogeneous study, the rest of the qualitative descriptive analysis. The results of this study showed no significant difference in the rates of disease-free survival, overall survival, local recurrence and distant metastasis between axillary lymph node dissection and sentinel lymph node dissection at different follow-up periods. Conclusions For sentinel lymph node biopsy in patients with single invasive breast cancer, negative axillary lymph node dissection may be unnecessary. There is still a need for high-quality randomized controlled trials and long-term follow-up to further confirm the conclusion of this systematic review.