Yu-Dong Qiu, Fang-Gui Xu, Yi-Tao Ding, Department of Hepatobiliary Surgery, Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China.
World J Gastroenterol. 2011 Jan 21;17(3):391-6. doi: 10.3748/wjg.v17.i3.391.
To evaluate the effect of preoperative biliary drainage (PBD) on obstructive jaundice resulting from malignant tumors.
According to the requirements of Cochrane systematic review, studies in the English language were retrieved from MEDLINE and Embase databases from 1995 to 2009 with the key word "preoperative biliary drainage". Two reviewers independently screened the eligible studies, evaluated their academic level and extracted the data from the eligible studies confirmed by cross-checking. Data about patients with and without PBD after resection of malignant tumors were processed for meta-analysis using the Stata 9.2 software, including postoperative mortality, incidence of postoperative pancreatic and bile leakage, abdominal abscess, delayed gastric emptying and incision infection.
Fourteen retrospective cohort studies involving 1826 patients with malignant obstructive jaundice accorded with our inclusion criteria, and were included in meta-analysis. Their baseline characteristics were comparable in all the studies. No significant difference was found in combined risk ratio (RR) of postoperative mortality and incidence of pancreatic and bile leakage, abdominal abscess, delayed gastric emptying between patients with and without PBD. However, the combined RR for the incidence of postoperative incision infection was improved better in patients with PBD than in those without PBD (P < 0.05).
PBD cannot significantly reduce the postoperative mortality and complications of malignant obstructive jaundice, and therefore should not be used as a preoperative routine procedure for malignant obstructive jaundice.
评估术前胆道引流（PBD）对恶性肿瘤引起的梗阻性黄疸的疗效。
根据 Cochrane 系统评价的要求，检索 1995 年至 2009 年 MEDLINE 和 Embase 数据库中使用“术前胆道引流”关键词的英文文献。由 2 位评价者独立筛选合格研究，并对合格研究进行学术水平评价和交叉核对后提取数据。使用 Stata 9.2 软件对接受和未接受恶性肿瘤切除术后 PBD 的患者的数据进行荟萃分析，包括术后死亡率、术后胰漏和胆漏、腹腔脓肿、胃排空延迟和切口感染的发生率。
符合纳入标准的 14 项回顾性队列研究共纳入 1826 例恶性梗阻性黄疸患者，进行荟萃分析。所有研究的基线特征均相似。接受和未接受 PBD 的患者术后死亡率和胰漏及胆漏、腹腔脓肿、胃排空延迟的联合风险比（RR）无显著差异。然而，接受 PBD 的患者术后切口感染的发生率改善更好（RR 为 0.39，95%CI：0.22-0.69，P < 0.05）。
PBD 不能显著降低恶性梗阻性黄疸的术后死亡率和并发症，因此不应作为恶性梗阻性黄疸的术前常规治疗。
