术前减黄对胰十二指肠切除术后并发症影响的系统评价-东南大学学报医学版

术前减黄对胰十二指肠切除术后并发症影响的系统评价

单位：1. 深圳市横岗人民医院普通外科,广东深圳 518115;
2. 广东医学院第一附属医院小儿外科, 广东湛江 524002;
3. 广东省中医院肝胆外科,广东广州 514003

关键词：梗阻性黄疸术前胆道引流胰十二指肠切除术并发症死亡率 Meta分析非随机同期对照试验

分类号：R657.43; R656.64; R657.5

出版年·卷·期（页码）：2012·31·第四期（425-430）

摘要：

目的:探讨术前胆道引流对梗阻性黄疸患者行胰十二指肠切除术(pancreaticoduodenectomy,PD)后并发症发生率及死亡率的影响。方法:检索1998年至2011年比较术前减黄与一期根治性手术对PD术后疗效的临床对照试验。对所检索到的文献纳入标准的评价,选择并发症发生率及死亡率为主要指标进行Meta分析。结果:共19项非随机对照试验及1项随机对照试验纳入本研究。胰十二指肠切除术前减黄与一期根治性手术在术后疗效,腹腔出血、消化道出血、腹腔感染、胃排空障碍、胆瘘、总体并发症发生率和死亡率方面两组间比较无明显差异,而减黄后切口感染及胰瘘发生率大于一期手术组。结论:术前减黄不能降低PD的手术并发症发生率和死亡率。

Objective: To evaluate the effect of preoperative biliary drainage(PBD) on the postoperative complications and mortality of pancreaticoduodenectomy (PD) through system analysis. Methods: The literatures that related to the comparison of the postoperation morbidity and mortality between patients received PD with and without PBD were reviewed from 1998 to 2011. The literatures were evaluated by the unified standards, which were the main standards to study the complications mobidity and mortality through Meta-analysis. Results: This study recruited nineteen nonrandomized concurrent control trails and one randomized concurrent control trail. In comparison between the PBD and the non-PBD group, except wound infection, there were no significant differences in abdominal bleeding, gastrointestinal bleeding, abdominal infection, delayed gastric emptying, biliary fistula, total complications mobidity and mortality; however, the PBD group achieved a higher complications mobidity of pancreatic leak and wound infection with statistical signficance. Conclusions: PBD does not decrease postoperative complications and morality.

参考文献：

[1] MARCUS S G,DOBRYANSKY M,SHAMAMIAN P,et al.Endoscopic biliary drainage before pancreaticoduodenectomy for periampullary malignancies[J].J Clin Gastroenterol,1998,26(2):125-129.
[2] HESLIN M J,BROOKS A D,HOCHWALD S N,et al.A preoperative biliary stent is associated with increased complications after pancreatoduodenectomy[J].Arch Surg,1998,133(2):149-154.
[3] POVOSKI S P,Jr KARPEH M S,CONLON K C,et al.Association of preoperative biliary drainage with postoperative outcome following pancreaticoduodenectomy[J].Ann Surg,1999,230(2):131-142.
[4] SOHN T A,YEO C J,CAMERON J L,et al.Do preoperative biliary stents increase post-pancreaticoduodenectomy complications?[J].J Gastrointest Surg,2000,4(3):258-268.
[5] MARTIGNONI M E,WAGNER M,KRAHENBUHL L,et al.Effect of preoperative biliary drainage on surgical outcome after pancreatoduodenectomy[J].Am J Surg,2001,181:52-59,87.
[6] SEWNATH M E,BIRJMOHUN R S,RAUWS E A,et al.The effect of preoperative biliary drainage on postoperative complications after pancreaticoduodenectomy[J].J Am Coll Surg,2001,192(6):726-734.
[7] SRIVASTAVA S,SIKORA S S,KUMAR A,et al.Outcome following pancreaticoduodenectomy in patients undergoing preoperative biliary drainage[J].Dig Surg,2001,18(5):381-387.
[8] PISTERS P W,HUDEC W A,HESS K R,et al.Effect of preoperative biliary decompression on pancreaticoduodenectomy associated morbidity in 300 consecutive patients[J].Ann Surg,2001,234(1):47-55.
[9] HODUL P,CREECH S,PICKLEMAN J,et al.The effect of preoperative biliary stenting on postoperative complications after pancreaticoduodenectomy[J].Am J Surg,2003,186:420-425.
[10] 毕新宇,邵永孚,蔡建强,等.术前减黄对重症黄疸患者行胰十二指肠切除术的影响[J].中国普通外科杂志,2004,13(6):441-444.
[11] BHATI C S,KUBAL C,SIHAG P K,et al.Effect of preoperative biliary drainage on outcome of classical pancreaticoduodenectomy[J].World J Gastroenterol,2007,13(8):1240-1242.
[12] SUDO T,MURAKAMI Y,UEMURA K,et al.Specific antibiotic prophylaxis based on bile cultures is required to prevent postoperative infectious complications in pancreatoduodenectomy patients who have undergone preoperative biliary drainage[J].World J Surg,2007,31:2230-2235.
[13] 陈东,梁力建,何耀彬,等.术前减黄对低位胆道恶性梗阻性黄疸患者行胰十二指肠切除术的影响[J].中华普通外科杂志,2007,22(2):119-122.
[14] ABDULLAH S A,GUPTA T,JAAFAR K A,et al.Ampullary carcinoma:effect of preoperative biliary drainage on surgical outcome[J].World J Gastroenterol,2009,15(23):2908-2912.
[15] LI Z,ZHANG Z,HU W,et al.Pancreaticoduodenectomy with preoperative obstructive jaundice:drainage or not[J].Pancreas,2009,38(4):379-386.
[16] COATES J M,BEAL S H,RUSSO J E,et al.Negligible effect of selective preoperative biliary drainage on perioperative resuscitation,morbidity,and mortality in patients undergoing pancreaticoduodenectomy[J].Arch Surg,2009,144(9):841-847.
[17] MEZHIR J J,BRENNAN M F,BASER R E,et al.A matched case-control study of preoperative biliary drainage in patients with pancreatic adenocarcinoma:routine drainage is not justified[J].J Gastrointest Surg,2009,13:2163-2169.
[18] 吴兴达,郭克建,赵梅芬,等.恶性梗阻性黄疸术前减黄的临床研究[J].中国医科大学学报,2010,39(4 ):308-310.
[19] 王剑雄,孔棣.术前减黄及相关因素对壶腹周围癌胰十二指肠切除术后并发症的影响[J].重庆医学,2011,40(32):3302-3303.
[20] MORRIS-STIFF G,TAMIJMARANE A,TAN Y M,et al.Pre-operative stenting is associated with a higher prevalence of post-operative complications following pancreatoduodenectomy[J].Int J Surg,2011,9(2):145-149.
[21] MIKE C.非随机对照试验和诊断性试验准确度系统评价的新挑战[J].中国循证医学杂志,2006,6:240-242.
[22] 范新,李俊生.甲磺酸伊马替尼对胰腺癌细胞体外生长的影响[J].现代医学,2006,34 (6):386-389.
[23] JOHNSON R C,AHRENDT S A.The case against preoperative biliary drainage with pancreatic resection[J].HPB (Oxford),2006,8:426-431.
[24] 刘永锋,宋少伟.恶性梗阻性黄疸病人术前减黄治疗的有关问题[J].中国实用外科杂志,2007,27(10):798-799.

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