摘要
目的系统评价术前常规行胆道引流(PBD)对胰十二指肠切除术(PD)术后并发症的影响。方法以preoperative biliary drainage、obstructive jaundice、pancreaticoduodenectomy、pancreatic head cancer、periampullary malignancy、biliary stricture、术前胆道引流、梗阻性黄疸、胰十二指肠切除术、胰头癌、壶腹部恶性肿瘤、胆道狭窄为关键词在Pubmed、Web of Science、Embase、The Cochrane Library、Ovid Journals、CNKI、万方、维普数据库检索2009年1月至2019年12月相关文献。对纳入文献提取PBD组和非PBD组(N-PBD组)术后胰瘘、胆漏、胃排空延迟、术区感染、腹腔感染发生率等数据进行Meta分析。结果最终纳入文献23篇,共计患者6 537例,其中PBD组3 479例,N-PBD组3 058例。Meta分析结果显示,PBD组胰瘘发生率为14.92%(505/3 385),明显高于N-PBD组的11.78%(359/2 964) (OR=1.19,95%CI:1.02~1.38,P=0.03);PBD组胃排空延迟发生率为13.40%(288/2 150),明显高于N-PBD组的11.72%(217/1 851) (OR=1.25,95%CI:1.03~1.52,P=0.02);PBD组术区感染发生率为14.97%(480/3 207),明显高于N-PBD组的6.78%(189/2 789) (OR=2.57,95%CI:2.14~3.09,P<0.001)。两组胆漏、腹腔感染、出血、心肺并发症、二次手术发生率和死亡率差异无统计学意义(P>0.05)。结论术前常规性PBD未给行PD的梗阻性黄疸患者带来明显的益处,反而增加胰瘘、胃排空延迟、术区感染发生率。
Objective To systematically evaluate the effect of preoperative biliary drainage(PBD)on the postoperative complications after pancreaticoduodenectomy(PD).Methods Literatures published between January 2009 to December 2019 were retrieved in PubMed,Web of Science,Embase,the Cochrane Library,Ovid Journals,CNKI,Wanfang Data and Chongqing VIP databases with the keywords of preoperative biliary drainage,obstructive jaundice,pancreaticoduodenectomy,pancreatic head cancer,periampullary malignancy,biliary stricture.Clinical data such as incidence of postoperative pancreatic fistula,bile leakage,delayed gastric emptying,operative area infection and abdominal infection of PBD and non-PBD groups(N-PBD group)were extracted and subjected to Meta-analysis.Results A total of23 articles consisting of 6537 patients were included.3479 cases were assigned in PBD group and 3058 cases in N-PBD group.Meta-analysis showed that the incidence of pancreatic fistula in PBD group was 14.92%(505/3385),significantly higher than 11.78%(359/2964)in N-PBD group(OR=1.19,95%CI:1.02-1.38,P=0.03).The incidence of delayed gastric emptying in PBD group was 13.40%(288/2150),significantly higher than 11.72%(217/1851)in N-PBD group(OR=1.25,95%CI:1.03-1.52,P=0.02).The incidence of operative area infection in PBD group was 14.97%(480/3207),significantly higher than 6.78%(189/2789)in N-PBD group(OR=2.57,95%CI:2.14-3.09,P<0.001).The incidence of bile leakage,abdominal infection,bleeding,cardiopulmonary complications,secondary operation and mortality did not significantly differ between two groups(P>0.05).Conclusions Routine PBD fails to bring significant benefits to patients with obstructive jaundice undergoing PD,whereas it increases the incidence of pancreatic fistula,delayed gastric emptying and operative area infection.
作者
曾齐
沙地克·阿帕尔吴警
努尔扎提江•安维尔
李涛
赵晋明
吐尔洪江·吐逊
Zeng Qi;Shadike·Apaer;Wu Jing;Nuerzhatijiang•Anweier;Li Tao;Zhao Jinming;Tuerhongjiang·Tuxun(Digestive Vascular Surgery Center,Department of Liver Transplantation and Laparoscopic Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)
出处
《中华肝脏外科手术学电子杂志》
CAS
2021年第2期174-180,共7页
Chinese Journal of Hepatic Surgery(Electronic Edition)
基金
新疆维吾尔自治区科技厅重点实验室开放课题项目(2018D04002)
新疆维吾尔自治区天山青年计划博士科技人才培养项目(2017Q094)。
