Zhang Bo, Lang Zekun, Zhu Kexiang, Luo Wei, Zhao Zhenjie, Zhang Zeliang, Wang Zhengfeng
The Forth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, Gansu, China.
The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, Gansu, China.
BMC Gastroenterol. 2025 Mar 11;25(1):161. doi: 10.1186/s12876-025-03761-x.
To investigate whether preoperative biliary drainage is beneficial for patients undergoing pancreaticoduodenectomy.
The PubMed, Cochrane Library and the Web of Science were systematically searched for relevant trials that included outcome of pancreaticoduodenectomy with and without preoperative biliary drainage from January 2010 to May 2024. The primary outcomes are postoperative pancreatic fistula and intra-abdominal infection. Data is pooled using the risk ratio or standardized mean difference with 95% confidence interval. The study protocol was registered prospectively with PROSPERO (CRD42022372584).
A total of 39 retrospective cohort studies with 33,516 patients were included in this trial. Compared with no preoperative biliary drainage, the preoperative biliary drainage group had a longer hospital stay (SMD, 0.14). Performing preoperative biliary drainage significantly increases the risk of postoperative pancreatic fistula (RR, 1.09), intra-abdominal infection (RR, 1.09), surgical site infection (RR, 1.84), and sepsis (RR, 1.37). But preoperative biliary drainage lowers risk of bile leak (RR, 0.74).
Preoperative biliary drainage before pancreaticoduodenectomy increases the risk of postoperative complications without clear overall benefits. Routine PBD is not recommended for younger patients with mild to moderate jaundice but may be considered for high-risk patients, such as those with severe infections or progressive jaundice. Optimizing preoperative biliary drainage duration and timing may help reduce complications. Further research is needed to refine patient selection and perioperative strategies.
探讨术前胆道引流对接受胰十二指肠切除术患者是否有益。
系统检索PubMed、Cochrane图书馆和科学网，查找2010年1月至2024年5月期间包含有或无术前胆道引流的胰十二指肠切除术结果的相关试验。主要结局为术后胰瘘和腹腔内感染。使用风险比或标准化均数差及95%置信区间汇总数据。该研究方案已在PROSPERO（CRD42022372584）进行前瞻性注册。
本试验共纳入39项回顾性队列研究，涉及33516例患者。与未进行术前胆道引流相比，术前胆道引流组住院时间更长（标准化均数差，0.14）。进行术前胆道引流显著增加术后胰瘘（风险比，1.09）、腹腔内感染（风险比，1.09）、手术部位感染（风险比，1.84）和脓毒症（风险比，1.37）的风险。但术前胆道引流降低了胆漏风险（风险比，0.74）。
胰十二指肠切除术前行术前胆道引流会增加术后并发症风险，且无明确的总体益处。不建议对轻至中度黄疸的年轻患者常规进行术前胆道引流，但对于高危患者，如严重感染或进行性黄疸患者，可考虑进行。优化术前胆道引流的持续时间和时机可能有助于减少并发症。需要进一步研究以优化患者选择和围手术期策略。
