Saleh Martha M A, Nørregaard Peter, Jørgensen Henrik L, Andersen Per K, Matzen Peter
Department of Gastroenterology, Hvidovre University Hospital, Denmark.
Gastrointest Endosc. 2002 Oct;56(4):529-34. doi: 10.1067/mge.2002.128161.
Pancreaticoduodenectomy is the only potentially curative treatment for peripapillary pancreatic tumors. However, postoperative morbidity and mortality are high, and different approaches have been tried to improve results, such as preoperative biliary drainage in patients with jaundice. This meta-analysis investigated the effect on postoperative outcome of preoperative biliary drainage by endoscopic biliary stent placement in patients who are jaundiced and who have peripapillary pancreatic tumors.
A Medline search for the period 1985 to 2001 was performed. Eight retrospective studies and 2 prospective randomized controlled trials were included. Selection criteria for the primary analysis were as follows: patients with peripapillary pancreatic cancer, endoscopic stent placement versus no stent, radical surgery, and assessment of postoperative morbidity and mortality. A secondary analysis included both radical and palliative surgery.
In the primary analysis, 337 patients underwent preoperative endoscopic biliary stent placement, and 412 patients had no endoscopic biliary stent placement (controls). The overall odds ratio for postoperative complications (stent vs. no stent) is estimated as 0.79: 95% CI [0.36, 1.73] and the estimated odds ratio for postoperative mortality is 0.81: 95% CI [0.33, 1.99]. In the secondary analysis, 1008 patients underwent preoperative EBS versus 720 control patients. The odds ratio for postoperative complications in this analysis was 0.93: 95% CI [0.65, 1.33] and for postoperative mortality is 1.12: 95% CI [0.62, 2.01].
No evidence was found of either a positive or adverse effect of preoperative endoscopic biliary stent placement on the outcome of surgery in patients with pancreatic cancer.
胰十二指肠切除术是治疗壶腹周围胰腺肿瘤唯一可能治愈的方法。然而，术后发病率和死亡率较高，人们尝试了不同方法来改善治疗效果，如对黄疸患者进行术前胆道引流。本荟萃分析研究了通过内镜放置胆道支架进行术前胆道引流对黄疸且患有壶腹周围胰腺肿瘤患者术后结局的影响。
检索了1985年至2001年期间的Medline数据库。纳入了8项回顾性研究和2项前瞻性随机对照试验。主要分析的选择标准如下：壶腹周围胰腺癌患者、内镜支架置入与未置入支架、根治性手术以及术后发病率和死亡率评估。次要分析包括根治性手术和姑息性手术。
在主要分析中，337例患者接受了术前内镜胆道支架置入，412例患者未置入内镜胆道支架（对照组）。术后并发症的总体比值比（支架置入组与未置入组）估计为0.79：95%可信区间[0.36, 1.73]，术后死亡率的估计比值比为0.81：95%可信区间[0.33, 1.99]。在次要分析中，1008例患者接受了术前内镜胆道支架置入，720例为对照患者。该分析中术后并发症的比值比为0.93：95%可信区间[0.65, 1.33]，术后死亡率的比值比为1.12：95%可信区间[0.62, 2.01]。
未发现术前内镜胆道支架置入对胰腺癌患者手术结局有正面或负面影响的证据。
