恶性阻塞性黄疸术前胆道引流的有效性和安全性的荟萃分析

Meta-analysis on the efficacy and safety of preoperative biliary drainage in patients with obstructive jaundice

目的评价术前胆道引流(preoperative biliary drainage,PBD)对恶性阻塞性黄疸手术治疗患者疗效的影响。方法通过计算机系统检索1995—2009年Medline数据库和Embase数据库中以英文检索词为"preoperative biliary drainage"的主题词,限定论文语种为英文的文献。采用Stata9.2软件进行荟萃分析。主要比较PBD组与未行PBD(NPBD)组术后病死率、胰瘘及胆瘘发生率、腹腔脓肿发生率、胃排空延迟发生率以及术后切口感染发生率。结果按照筛选标准,共有14篇文献1 826例恶性阻塞性黄疸患者入选。PBD患者术后、胰瘘及胆瘘发生率、腹腔脓肿发生率、胃排空延迟发生率与NPBD的恶性黄疸患者相比,差异均无统计学意义(P值分别为0.986,0.364,0.786,0.819,0.265);术后切口感染率PBD组明显高于NPBD组,差异有统计学意义(P=0.002)。结论荟萃分析显示PBD并未提高恶性阻塞性黄疸患者术后的疗效及有效性和安全性,因此没有必要将胆道引流作为恶性阻塞性黄疸患者的常规术前准备措施。

Objective To evaluate the effectiveness of preoperative biliary drainage（PBD） in patients with obstructive jaundice resulting from malignant tumors.Methods According to the requirements of Cochrane systematic review,a thorough literature search was performed in Medline and Embase electronic databases between 1995 and 2009 in terms of the key words preoperative biliary drainage,restricted articles for the English language.Two reviewers independently screened the studies for eligibility,evaluated the quality and extracted the data from the eligible studies with confirmation by cross-checking.Data were processed for a meta-analysis by Stata 9.2 software.Comparison was performed between PBD patients and patients without PBD,who both subsequently underwent resection of the malignant tumors,including the indices such as postoperative mortality,the incidence of postoperative pancreatic leakage,bile leakage,abdominal abscess,delayed gastric emptying and incision infection.Results There were 14 papers with 1 826 malignant obstructive jaundice patients selected and analysed,The combined RR values of postoperative mortality,the incidence of pancreatic leakage,bile leakage,abdominal abscess,and delayed gastric emptying between PBD patients and patients without PBD were not statistically significant（P=0.986,0.364,0.786,0.819,0.265,respectively）;but the incidence of postoperative incision infection was improved in PBD group versus that in non-PBD group（P=0.002）.Conclusions PBD did not significantly improve the postoperative efficacy and safety in patients with malignant obstructive jaundice.Therefore,PBD may not be regarded as a preoperative routine measure for patients with malignant obstructive jaundice.