术前减黄对胰十二指肠切除术后并发症影响的系统评价

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。

Systematic analysis on the effect of preoperative biliary drainage on the postoperative complications of pancreaticoduodenectomy

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.