摘要
目的探讨术前胆道引流对恶性肿瘤所致梗阻性黄疸患者术后转归的影响。方法文献检索来自Cochrane对照研究注册中心及其肝胆亚组的临床对照研究,PUBMED/MEDLINE、EMBASE、SCI以及SCIE数据库2017年11月以前发表的随机对照研究、非随机的前瞻性对照研究。检索词包括:randomized/randomize/random,prospective,preoperative biliary drainage,obstructive jaundice,pancreaticoduodenectomy,periampullar carcinoma,hilar cholangiocarcinoma。根据改良Jadad评分量表对纳入的文献进行质量控制和筛选。Meta分析采用随机效应模式。结果 6篇随机对照研究,5篇非随机前瞻性研究共计987例患者被纳入Meta分析,其中术前胆道引流组477例,早期手术组510例。术前胆道引流与早期手术组患者相比,在术后总体并发症、切口感染、腹腔感染、肺部感染发生率以及围手术期死亡率方面差异无统计学意义(OR=1.12,1.36,2.07,0.57,1.11;P>0.05);而术前胆道引流组术后1年生存率较差(OR=0.60,P<0.05)。结论恶性肿瘤所致的梗阻性黄疸术前胆道引流并未使患者明显获益,反而有降低患者1年生存率的风险。
Objective To evaluate the effect of preoperative biliary drainage on the postoperative outcomes of patients with obstructive jaundice caused by malignant tumors. Methods Literature search of clinical control trials from Cochrane Controlled Trials Register Center and its hepatobiliary subgroup, randomized controlled studies and non-randomized prospective controlled studies published before November 2017 in PUBMED/MEDLINE, EMBASE, SCI and Science Citation Index Expanded （SCIE） databases were conducted. Search terms included randomized/randomize/random, prospective, preoperative biliary drainage, obstructive jaundice, pancreatico-duodenectomy, periampullar carcinoma and hilar cholangiocarcinoma. Quality control and screening of the included literatures were performed according to the modified Jadad Scale. Meta-analysis was conducted using a random effect model. Results 6 randomized controlled trials and 5 non-randomized prospective studies consisting of 987 patients were included in the Meta-analysis. There were 477 patients in preoperative biliary drainage group and 510 cases in early surgery group. No significant difference was observed in the overall incidence of postoperative complications, incision infection, abdominal infection, lung infection and perioperative mortality between two group （OR=1.12, 1.36, 2.07, 0.57, 1.11;P〉0.05）. The postopoerative 1-year survival in preoperative biliary drainage group was significantly worse compared with that in early surgery group （OR=0.60, P〈0.05）. Conclusions Preoperative biliary drainage of obstructive jaundice caused by malignant tumors fails to bring significant benefits for patients, whereas has the risk of reducing the postoperative 1-year survival.
作者
蓝翔
魏永刚
李波
Lan Xiang;Wei Yonggang;Li Bo(Department of Hepatobiliary Surgery,Department of Liver Transplantation,West China Hospital,Sichuan University,Chengdu 610041,China)
出处
《中华肝脏外科手术学电子杂志》
CAS
2018年第4期295-299,共5页
Chinese Journal of Hepatic Surgery(Electronic Edition)
