摘要
目的 系统性评估术前胆道引流(PBD)对恶性梗阻性黄疸患者胰十二指肠切除术(PD)术后并发症的影响,以期为临床实践决策提供参考。方法 计算机检索PubMed、Embase、Web of Science、The Cochrane Library、中国知网、维普、万方、中国生物医学文献数据库2014年1月1日至2026年2月10日公开发表的PBD对PD术后影响的研究,根据纳排标准筛选相关文献,评估文献质量,提取相应数据资料,采用RevMan5.4、Stata 17.0软件对纳入文献进行Meta分析。结果 共纳入42项研究,共计19 036例患者,其中非PBD组12 156例,NPBD组6 880例。Meta分析结果显示,PBD组术后出血发生率低于非PBD组[OR=0.80,95%CI(0.66,0.96),P=0.02],而伤口感染发生率高于非PBD组[OR=1.92,95%CI(1.54,2.39),P<0.001];两组在总体并发症、胰瘘、胆漏、腹腔感染、胃排空延迟发生率及围手术期死亡率方面差异无统计学意义(P > 0.05)。结论 PBD可显著降低术后出血风险,但可能增加伤口感染发生率。目前证据尚不能支持PBD可全面改善预后,未来需开展多中心随机对照试验,进一步明确PBD的获益人群及标准化操作流程。
Objective To systematically evaluate the impact of preoperative biliary drainage(PBD)on postoperative complications in patients with malignant obstructive jaundice undergoing pancreaticoduodenectomy(PD),thereby providing evidence for clinical decisionmaking.Methods A comprehensive search of PubMed,Embase,Web of Science,The Cochrane Library,CNKI,VIP,Wanfang,and CBM databases was conducted for studies published between January 1,2014 and February 10,2026.Literature screening,quality assessment,and data extraction were performed according to predefined inclusion/exclusion criteria.Statistical analyses of postoperative complications were conducted using RevMan 5.4 and Stata 17.0.Results A total of 42 studies were included,involving 19,036 patients,with 12,156 patients in the PBD group and 6,880 in the non-PBD(NPBD)group.Meta-analysis revealed that the incidence of postoperative hemorrhage was lower in the PBD group than in the NPBD group[OR=0.80,95%CI(0.66,0.96),P=0.02];the incidence of wound infection was higher in the PBD group than in the NPBD group[OR=1.92,95%CI(1.54,2.39),P<0.001].No statistically significant differences were observed between the two groups in the incidence of overall complications,pancreatic fistula,bile leakage,intra-abdominal infection,delayed gastric emptying,or perioperative mortality(P>0.05).Conclusion Preoperative biliary drainage significantly reduces the risk of postoperative bleeding but may increase the incidence of wound infection.Current evidence is insufficient to support that PBD can comprehensively improve prognosis.Future multicenter randomized controlled trials are warranted to identify optimal candidates and standardize procedural protocols for PBD.
作者
赵学安
杨尚儒
李昕
周文策
ZHAO Xue'an;YANG Shangru;LI Xin;ZHOU Wence(The Second Clinical Medical School,Lanzhou University,Lanzhou 730000,China;Department of General Surgery,The Second Hospital of Lanzhou University,Lanzhou 730000,China)
出处
《医学新知》
2026年第2期194-202,共9页
New Medicine
基金
国家自然科学基金地区科学基金项目(82260555)
甘肃省科技重大专项(22ZD6FA021-4)。
关键词
胰十二指肠切除术
术前胆道引流
梗阻性黄疸
并发症
META分析
Pancreaticoduodenectomy
Preoperative biliary drainage
Obstructive jaundice
Postoperative complications
Meta-analysis
