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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2021, Vol. 10 ›› Issue (02) : 174 -180. doi: 10.3877/cma.j.issn.2095-3232.2021.02.012

所属专题： 文献；

临床研究

术前胆道引流对胰十二指肠切除术后并发症影响的Meta分析
曾齐1, 沙地克·阿帕尔1, 吴警1, 努尔扎提江·安维尔1, 李涛1, 赵晋明1, 吐尔洪江·吐逊1,†()   
  1. 1. 830054　乌鲁木齐，新疆医科大学第一附属医院消化血管外科中心　肝移植·腹腔镜外科
  • 收稿日期:2020-12-06 出版日期:2021-04-10
  • 通信作者: 吐尔洪江·吐逊
  • 基金资助:
    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)

Effect of preoperative biliary drainage on postoperative complications after pancreaticoduodenectomy: a Meta-analysis

Qi Zeng1, Apaer Shadike·1, Jing Wu1, Anweier Nuerzhatijiang·1, Tao Li1, Jinming Zhao1, Tuxun Tuerhongjiang·1,†()   

  1. 1. Digestive Vascular Surgery Center, Department of Liver Transplantation and Laparoscopic Surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
  • Received:2020-12-06 Published:2021-04-10
  • Corresponding author: Tuxun Tuerhongjiang·
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引用本文：

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. 术前胆道引流对胰十二指肠切除术后并发症影响的Meta分析[J]. 中华肝脏外科手术学电子杂志, 2021, 10(02): 174-180.

Qi Zeng, Apaer Shadike·, Jing Wu, Anweier Nuerzhatijiang·, Tao Li, Jinming Zhao, Tuxun Tuerhongjiang·. Effect of preoperative biliary drainage on postoperative complications after pancreaticoduodenectomy: a Meta-analysis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(02): 174-180.

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。

关键词: 胰十二指肠切除术, 引流术, 黄疸, 阻塞性, 手术后并发症, Meta分析
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 of 23 articles consisting of 6 537 patients were included. 3 479 cases were assigned in PBD group and 3 058 cases in N-PBD group. Meta-analysis showed that the incidence of pancreatic fistula in PBD group was 14.92%(505/3 385), significantly higher than 11.78%(359/2 964) 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%(288/2 150), significantly higher than 11.72%(217/1 851) 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%(480/3 207), significantly higher than 6.78%(189/2 789) 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.

Key words: Pancreaticoduodenectomy, Drainage, Jaundice, obstructive, Postoperative complications, Meta-analysis
表1 纳入文献基本特征及研究质量评价
作者 年份 国家 研究类型 样本量（例） 引流方式 NOS评分
PBD组 N-PBD组
van der Gaag等[4] 2010 英国 随机对照研究 102 94 ERCP/PTCD 低风险
Mezhir等[5] 2009 美国 病例对照研究 94 94 ERCP/PTCD 7
陈元岩等[6] 2010 中国 病例对照研究 24 54 PTCD 6
Morris-Stiff等[7] 2011 英国 病例对照研究 118 162 ERCP/PTCD 6
吕湖等[8] 2011 中国 病例对照研究 46 90 PTCD/ERBD/EMBE 6
王剑雄等[9] 2011 中国 病例对照研究 33 30 PTCD/ENBD 6
冯健等[10] 2012 中国 病例对照研究 133 239 PTCD/ERCP 7
孙孝文等[11] 2012 中国 病例对照研究 19 52 PTCD/ERCP 7
段姚尧等[12] 2012 中国 病例对照研究 40 34 PTCD 6
Singhirunnusorn等[13] 2013 法国 病例对照研究 38 62 ERCP 7
Cavell等[14] 2013 美国 病例对照研究 220 289 ERCP/ENBD 7
王介营等[15] 2013 中国 病例对照研究 41 43 PTCD/ENBD 6
di Mola等[16] 2014 德国 病例对照研究 53 40 ERCP/PTCD 7
Arkadopoulos等[17] 2014 希腊 病例对照研究 76 76 ERCP 7
Liu等[18] 2015 中国 病例对照研究 47 47 ERCP/PTCD/ENBD 6
Uemura等[19] 2015 日本 病例对照研究 573 359 PTBD/ERCP 6
Sahora等[20] 2016 日本 病例对照研究 500 500 ERCP 7
El Nakeeb等[21] 2016 埃及 病例对照研究 314 274 PTCD/ENBD 7
De Pastena等[22] 2018 意大利 病例对照研究 714 258 ERCP/PTBD 7
周永平等[23] 2018 中国 病例对照研究 30 43 ERCP/ENBD 7
许马川等[24] 2018 中国 病例对照研究 36 42 PTCD/ENBD/ERCP 6
李刚等[25] 2019 中国 病例对照研究 49 63 ENBD 7
Endo等[26] 2019 日本 病例对照研究 179 113 ENBD/ERBD 7
图1 PBD组与N-PBD组PD术后胰瘘Meta分析森林图
图2 胰瘘发生率的文献发表偏倚漏斗图
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