术前胆道引流对梗阻性黄疸预后的影响:一项伞状评价

Effect of Preoperative Biliary Drainage on the Prognosis of Obstructive Jaundice:an Umbrella Review

目的评估术前胆道引流对梗阻性黄疸预后的影响。方法计算机检索PubMed、Web of Science、EMBase、The Cochrane Library数据库,检索有关术前胆道引流对梗阻性黄疸预后影响的系统回顾性研究或荟萃分析,由两名研究者独立根据纳入和排除标准进行评估,使用AMSTAR和GRADE进行治疗评价。结果共纳入17篇荟萃分析,其纳入研究的文献数量为5~44篇,中位数为14篇;样本量为312~23076例,中位数为1860例。共提取36项结局指标进行分析。分析表明术前胆道引流与17项指标显著相关,在术后胆红素水平、术后肝功能不全发生率、术后肝衰竭发生率3个指标具有显著优势。其余指标未能呈现改善趋势。直接手术在并发症发病率、死亡率、生存率等指标上优于术前胆道引流。结论对于大多数梗阻性黄疸患者来说,并不能从术前胆道引流中获益。因此并不能将术前胆道引流作为常规术前准备。如何判断使用术前胆道引流的适应症,最大程度上使患者获益,由于大多数结果的证据较低,未来需要更多的前瞻性队列研究。

Objectives To evaluate the effect of preoperative biliary drainage on the prognosis of obstructive jaundice.Methods PubMed,Web of Science,EMBase,and The Cochrane Library databases were used to retrieve systematic retrospective studies or meta-analyses on the impact of preoperative biliary drainage on the prognosis of obstructive jaundice.Two researchers independently evaluated the effects according to the inclusion and exclusion criteria,and AMSTAR and GRADE were used for treatment evaluation.Results A total of 17 meta-analyses were included.The number of studies ranged from 5 to 44,with a median of 14.The sample size ranged from 312 to 23076 cases,with a median of 1860 cases.A total of 36 outcome indicators were extracted for analysis.The analysis showed that preoperative biliary drainage was significantly correlated with 17 indicators,and had significant advantages in the level of postoperative bilirubin,the incidence of postoperative liver dysfunction,and the incidence of postoperative liver failure.The remaining indicators failed to show an improvement trend.Direct operation is superior to preoperative biliary drainage in terms of incidence of complications,mortality and survival rate.Conclusions Most patients with obstructive jaundice do not benefit from preoperative biliary drainage.Therefore,preoperative biliary drainage cannot be used as a routine preoperative preparation.As for how to determine the indications for preoperative biliary drainage and maximize the benefits of patients,more prospective cohort studies are needed in the future due to the limited evidence of most results.