术前减黄对阻塞性黄疸治疗效果的随机对照试验Meta分析

Meta analysis on efficacy of preoperative biliary drainage in obstructive jaundice

目的 探讨梗阻性黄疸患者行术前胆道引流（PBD）的有效性。方法 以“术前胆道引流”和“随机对照试验（RCT）”为关键词从PubMed、EMBASE、Cochrane Library和CNKI等数据库搜索2015年10月前的所有中文和英文文献。使用Stata12.0软件对相关数据进行统计分析,合并效应量用风险比（RR）或加权均数差（WMD）及其95%CI来估计。结果 6篇RCT,共498例良性或恶性梗阻性黄疸患者（PBD组和非PBD各249人）符合纳入标准。PBD组和非PBD组的术后并发症（RR=0.966,95%CI：0.775-1.203,P=0.757）,住院时间（WMD=2.409,95%CI：-0.970-5.788,P=0.162）和治疗的病死率（RR=1.156,95%CI：0.660-1.027,P=0.062）均差异无统计学意义。在治疗并发症方面PBD组比非PBD组患者有显著增加（RR=1.445,95%CI：1.027-2.033,P〈0.05）。结论 现阶段术前行胆道引流减黄治疗在增加着治疗并发症的同时并没有为梗阻性黄疸患者带来其他好处,因此,在RCT中不推荐常规行PBD治疗。

Objective To investigate the effect of preoperative biliary drainage （PBD） in the patients with obstructive jaun- dice. Methods All English and Chinese literatures were searched from the databases of PubMed. EMBASE,Cochrane Library and CNKI, etc. until October 2015 with the key word ＂preoperative biliary drainage＂ and ＂randomized controlled trial （RCT）＂. The re- lated data were statistically analyzed by using the Statal2.0 software. Then the merged effect amount was estimated by the risk ra- tio（RR） or weighted mean difference （WMD） and 95% confidence interval （CI）. Results Six randomized controlled trials（RCT） were included in the standard,involving 498 patients with benign or malignant obstructive jaundice （249 cases in the PBD group and 249 in the non-PBD group）. There were no statistically significant differences between the PBD group and non-PBD group in post- operative complications（RR=0. 966;95%CI：0. 775-1. 203;P=0. 757）,hospital stay （WMD=2. 409;95%CI： -0. 970-5. 788; P〈0. 162） and treatment, mortality （RR = 1. 156 ; 95%CI： 0. 660- 1. 027 % P= 0.062）. However. the treatment complications in the PBD group was significantly increased compared with the non-PBD group（RR= 1. 445;95% CI：1. 027- 2. 033;P〈0.05）. Conclu- sion Conducting PBD for reducing jaundice at the present stage increases the treatment complications,meanwhile does not bring other benefits to the patients with obstructive jaundice. Therefore the routine PBD therapy does not recommended in RCT.