摘要
目的 系统评价恶性梗阻性黄疸胰十二指肠切除术前行胆道引流的疗效.方法 以malignant obstructive jaundice、pancreaticoduodenectomy、preoperative biliary drainage、comparative study为检索词,检索2001年1月至2013年12月PubMed、EMBASE、Cochrane library对照试验中心注册数据库、学位论文数据库与重要会议数据库.对胰十二指肠切除术前行胆道引流与早期手术疗效的随机对照试验文献进行Meta分析.将术前行胆道引流的患者设为术前胆道引流组,行早期手术患者设为早期手术组.计数资料采用优势比（OR）、相对危险度（RR）及95％可信区间（95％ CI）表示.计量资料采用均数差（MD）及95％ CI表示.采用I2检验对异质性进行分析.采用固定或随机效应模型合并数据.结果 最终纳入符合标准的相关研究共12篇,累计样本量1 982例患者,其中术前胆道引流组1 029例,早期手术组953例.Meta分析结果显示：术前胆道引流组患者手术时间、术中出血量、术后切口感染率均大于早期手术者,差异有统计学意义（MD=10.50,107.92,95％CI：6.34 ～ 14.66,16.43 ～ 199.42;RR=1.62,95％CI：1.19 ～2.21,P＜0.05）;术后胰瘘发生率、术后胆汁漏发生率、术后胃排空延迟发生率、术后住院时间、术后病死率两组比较,差异无统计学意义（RR=0.69,95％ CI：0.52～0.92;0R =0.68,1.35,95％ CI：0.38 ～ 1.21,0.93～1.95;MD =0.69,95％ CI：-0.67 ～2.05;RR =0.00,95％ CI：-0.02～0.01,P＞0.05）.结论 恶性梗阻性黄疸胰十二指肠切除术患者术前行胆道引流并不能降低术后并发症发生率和病死率,术前行胆道引流不应作为围术期的常规处理措施.
Objective To evaluate the efficacy of preoperative biliary drainage （PBD） in the pancreaticoduodenectomy for malignant obstructive jaundice.Methods Database including PubMed,EMBASE,Cochrane Central Register of Controlled Trials,Academic Degree Dissertation Database and Conference Database were searched with ＂malignant obstructive jaundice＂,＂pancreaticoduodenectomy＂,＂preoperative biliary drainage＂,＂comparative study＂.Literatures about the randomized controlled trials of PBD （PBD group） and efficacy of early surgery （ES group） in the pancreaticoduodenectomy were retrieved from January 2001 to December 2013,and then a Meta analysis was carried out based on the data.The count data were analyzed using the odds ratio （OR）,relative risk （RR） and 95% confidence interval （95% CI）,and the measurement data were analyzed using mean difference （MD） and 95% CI.The heterogeneity of the data was analyzed using the I2 test.Data were integrated by fixed or random effect model.Results Twelve literatures including 1 982 patients were selected.There were 1 029 patients in the PBD group and 953 in the ES group.The results of Meta analysis showed that the operation time,volume of blood loss and rate of postoperative wound infection in the PBD group were significantly different from those in the ES group （MD =10.50,107.92,95% CI：6.34-14.66,16.43-199.42;RR =1.62,95%CI：1.19-2.21,P 〈0.05）.There were no significant differences in the postoperative mortality,incidence of pancreatic fistula,incidence of bile leakage,incidence of delayed gastric emptying and duration of hospital stay between the 2 groups （RR=0.69,95%CI：0.52-0.92;OR =0.68,1.35,95%CI：0.38-1.21,0.93-1.95;MD =0.69,95%CI：-0.67-2.05;RR =0.00,95% CI：-0.02-0.01,P 〉0.05）.Conclusion PBD in the pancreaticoduodenectomy for malignant obstructive jaundice cannot reduce postoperative mortality and incidence of complications in patients,and should not be used as the conventional management in the perioperative period.
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2015年第4期298-304,共7页
Chinese Journal of Digestive Surgery
基金
安徽省卫生厅科研基金（098098）
