ABSTRACT
Objective To evaluate the efficacy of preoperative biliary drainage (PBD) in the pancreaticoduodenectomy for malignant obstructive jaundice.Methods Database including PubMed,EMBASE,Cochrane Central Register of Controlled Trials,Academic Degree Dissertation Database and Conference Database were searched with malignant obstructive jaundice,pancreaticoduodenectomy,preoperative biliary drainage,comparative study.Literatures about the randomized controlled trials of PBD (PBD group) and efficacy of early surgery (ES group) in the pancreaticoduodenectomy were retrieved from January 2001 to December 2013,and then a Meta analysis was carried out based on the data.The count data were analyzed using the odds ratio (OR),relative risk (RR) and 95％ confidence interval (95％ CI),and the measurement data were analyzed using mean difference (MD) and 95％ CI.The heterogeneity of the data was analyzed using the I2 test.Data were integrated by fixed or random effect model.Results Twelve literatures including 1 982 patients were selected.There were 1 029 patients in the PBD group and 953 in the ES group.The results of Meta analysis showed that the operation time,volume of blood loss and rate of postoperative wound infection in the PBD group were significantly different from those in the ES group (MD =10.50,107.92,95％ CI:6.34-14.66,16.43-199.42;RR =1.62,95％CI:1.19-2.21,P ＜0.05).There were no significant differences in the postoperative mortality,incidence of pancreatic fistula,incidence of bile leakage,incidence of delayed gastric emptying and duration of hospital stay between the 2 groups (RR=0.69,95％CI:0.52-0.92;OR =0.68,1.35,95％CI:0.38-1.21,0.93-1.95;MD =0.69,95％CI:-0.67-2.05;RR =0.00,95％ CI:-0.02-0.01,P ＞0.05).Conclusion PBD in the pancreaticoduodenectomy for malignant obstructive jaundice cannot reduce postoperative mortality and incidence of complications in patients,and should not be used as the conventional management in the perioperative period.
ABSTRACT
Objective To evaluate the clinical effectiveness of laparoscopic (LDP) versus open distal pancreatectomy (ODP) using meta-analysis.Methods Comprehensive literature search was conducted on articles only in English published from 2006 to 2012 on MEDLINE,EMbase,Cochrane Central Registry of Controlled Trials to compare LDP with ODP for Pancreatic disease.Data were extracted and evaluated by two reviewers independently.The quality of the included trials was evaluated.Meta-analyses were conducted using the Cochrane Collaboration's RevMan 5.1 software.Results Fourteen controlled clinical trials (n=1417) were included.The LDP group was significantly longer than the ODP group in operation time,and was significantly larger in the number of patients with spleen preservation [(MD-273.10,95％ CI-354.39-191.081,P＜0.01),(OR 2.42,95％ CI 1.78-3.30,P＜0.01) respectively].The LDP group was significantly less than the ODP group in intraoperative blood loss,time to oral intake,and length of hospital stay [(MD-273.10,95％ CI -354.39-191.81,P＜0.01),(MD-1.78,95％ CI-2.36-1.20,P＜0.01),(MD-3.15,95％ CI-3.97-2.33,P＜0.01) respectively].There were no significant differences in blood transfusion,pancreatic fistula rate,and mortality between the two groups.Conclusions LDP is feasible and safe in treating pancreatic disease.When compared with ODP,LDP has the advantages of having less intraoperative blood loss,quicker recovery and more patients with spleen preservation.