中国普通外科杂志 ›› 2011, Vol. 20 ›› Issue (2): 123-128.

• 胆道肿瘤专题研究 • 上一篇    下一篇

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

徐方贵1|顾劲扬2|柏建岭3|仇毓东2   

  1. (1.南京军区福州总院第一附属医院 肝胆外科|福建 莆田 351100; 2.南京大学医学院附属鼓楼医院 肝胆外科|江苏 南京 210008; 3.南京医科大学 流行病与卫生统计学系|江苏 南京 210029)
  • 收稿日期:2010-01-01 修回日期:2010-12-02 出版日期:2011-02-15 发布日期:2011-02-15
  • 通讯作者: 仇毓东 E-mail:yudongqiu510@163.com
  • 作者简介:徐方贵|南京军区福州总院第一附属医院主治医师|主要从事肝脏肿瘤方面的研究。

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

XU Fanggui1, |GU Jinyang2, BAI Jianling3, QIU Yudong2   

  1. (1.Department of Hepatobiliary Surgery,the First Affiliated Hospital of Fuzhou General Hospital, Nanjing Military Area,PLA,Putian, Fujian 351100,China|2.Department of Hepatobiliary Surgery, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China|3.Department of Epidemiology and Biostatistics, Nanjing Medical University, Nanjing 210029, China)
  • Received:2010-01-01 Revised:2010-12-02 Online:2011-02-15 Published:2011-02-15

摘要:

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。

关键词: 黄疸, 阻塞性/治疗; 术前胆道引流; , 病死率; 手术后并发症/预防与控制; 荟萃分析

Abstract:

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.

Key words: Jaundice, Obstructive/ther, Preoperative Biliary Drainage; , Mortality, Postoperative Complications/prev, Meta-analysis

中图分类号: 

  • R 735.8

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