Effectiveness of preoperative biliary drainage for malignant obstructive jaundice: a systematic review and meta-analyses of randomized controlled trials

doi:10.3877/cma.j.issn.1674-0793.2011.01.020

Abstract

Abstract:

Objective

To determine the benefits and harms of preoperative biliary drainage (PBD) in malignant obstructive jaundice.

Methods

The Cochrane Library, PubMed, EMBASE, Chinese Biomedical Literature Database were searched up to June 2010 added with handsearching and other retriecals. The Cochrane Collaboration’s RevMan 5.0 was used for Meta-analyses.

Results

Seven RCTs were included. Meta-analyes showed no significant difference of mortality (P=0.88) and overall morbidity (P=0.66) between PBD group and controlled group. Lower postoperative morbidity was found in percutaneous transhepatic biliary drainage (PTBD) group(OR=0.49, 95% CI=0.31-0.79, P=0.003), the patients with high bilirubinemia (serum total bilirubin>200 μmol/L) (OR=0.56, 95% CI=0.37-0.84, P=0.006) and PBD less than 4 weeks (OR=0.60, 95% CI=0.39-0.93, P=0.02) significantly.

Conclusions

Selecting the appropriate cases, taking appropriate drainage way, controlling proper drainage time, PBD could decrease postoperative morbidity of malignant obstructive jaundice but has no significant beneficial effect on mortality and overall morbidity.

Key words: Obstructive jaundice, Preoperative biliary drainage, Meta-analyses, Systematic review

Chen XU, Jin-tang XIA, Bo XU, Wen-song CAI, Yue-yuan LAI, Zhao-feng WU. Effectiveness of preoperative biliary drainage for malignant obstructive jaundice: a systematic review and meta-analyses of randomized controlled trials[J]. Chinese Archives of General Surgery(Electronic Edition), 2011, 05(01): 68-74.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhptwkxwx.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0793.2011.01.020

https://zhptwkxwx.cma-cmc.com.cn/EN/Y2011/V05/I01/68

Figures/Tables 8

References 20

1	Gouma DJ, van Geenen RC, van Gulik TM, et al. Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg, 2000, 232(6): 786-795.
2	Whipple AO, Parsons WB, Mullins CR, et al. Treatment of carcinoma of the ampulla of Vater. Ann Surg, 1935, 102(4): 763-779.
3	Nakayama T, Ikeda A, Okuda K, et al. Percutaneous transhepatic drainage of the biliary tract: technique and results in 104 cases. Gastroenterology, 1978, 74(3): 554-559.
4	Gundry SR, Strodel WE, Knol JA, et al. Efficacy of preoperative biliary tract decompression in patients with obstructive jaundice. Arch Surg, 1984, 119(6): 703-708.
5	McPherson GA, Benjamin IS, Hodgson HJ, et al. Pre-operative percutaneous transhepatic biliary drainage: the results of a controlled trial. Br J Surg, 1984, 71(5): 371-375.
6	Pitt HA, Gomes AS, Lois JF, et al. Does preoperative percutaneous biliary drainage reduce operative risk or increase hospital cost?. Ann Surg, 1985, 201(5): 545-553.
7	三浦修, 羽生富士夫, 今泉俊秀, 等.术前减黄处置の功罪. 胆と胰, 1989, 10(3): 561-564.
8	沈魁, 田雨霖, 慈福承, 等. 恶性梗阻性黄疸术前减黄的利弊和方法. 中华外科杂志, 1991, 29(1): 56-58.
9	Sewnath ME, Karsten TM, Prins MH, et al. A meta-analysis on the efficacy of preoperative biliary drainage for tumors causing obstructive jaundice. Ann Surg, 2002, 236(1): 17-27.
10	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials, 1996, 17(1): 1-12.
11	Hatfield AR, Tobias R, Terblanche J, et al.Preoperative external biliary drainage in obstructive jaundice. A prospective controlled clinical trial. Lancet, 1982, 2(4): 896-899.
12	Lai EC, Mok FP, Fan ST, et al. Preoperative endoscopic drainage for malignant obstructive jaundice. Br J Surg, 1994, 81(8): 1195-1198.
13	Wig JD, Kumar H, Suri S, et al. Usefulness of percutaneous transhepatic biliary drainage in patients with surgical jaundice-a prospective randomised study. J Assoc Physicians India, 1999, 47(3): 271-274.
14	田伏洲, 石力, 汤礼军, 等. 胰头癌术前减黄指征的前瞻性研究. 中华外科杂志, 2006, 44(23): 1614-1616.
15	van der Gaag NA, Rauws EA, van Eijck CH, et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med, 2010, 362(2): 129-137.
16	田伏洲, 石力, 汤礼军, 等. 对恶性梗阻性黄疸术前减黄指标的再认识(附28例临床分析). 中国现代普通外科进展, 2010, 13(1): 1-4.
17	何晓东, 康维明. 恶性梗阻性黄疽的术前减黄与Ⅱ期手术. 中国医刊, 2002, 37(12): 14-16.
18	Mansfield SD, Barakat O, Charnley RM, et al. Management of hilar cholangiocarcinoma in the North of England: pathology, treatment, and outcome. World J Gastroenterol, 2005, 11(48): 7625-7630.
19	Hochwald SN, Burke EC, Jarnagin WR, et al. Association of preoperative biliary stenting with increased postoperative infectious complications in proximal cholangiocarcinoma. Arch Surg, 1999, 134(3): 261-266.
20	Hemming AW, Reed AI, Fujita S, et al. Surgical management of hilarcholangiocarcinoma. Ann Surg, 2005, 241(5): 699-702.

第一作者/发表年	研究例数	平均年龄（岁）	恶性黄疸比例（%）	入院TB（μmol/L）	减黄方法	减黄时间（d）
Hatfield 1982^[11]	55	61.8	95	360	PTBD	7~10
McPherson 1984^[5]	65	61.8	100	350	PTBD	18
Pitt 1985^[6]	75	60.6	77	287.3	PTBD	11
Lai 1994^[12]	87	66.4	100	266	ERBD	18
Wig 1999^[13]	40	61.8	60	386	PTBD	42.5
田伏洲2006^[14]	183	50	100	279	PTBD	21
Van der Gaag 2010^[15]	196	64.7	92	154	ERBD	36.4

第一作者/发表年	研究例数	平均年龄（岁）	恶性黄疸比例（%）	入院TB（μmol/L）	减黄方法	减黄时间（d）
Hatfield 1982^[11]	55	61.8	95	360	PTBD	7~10
McPherson 1984^[5]	65	61.8	100	350	PTBD	18
Pitt 1985^[6]	75	60.6	77	287.3	PTBD	11
Lai 1994^[12]	87	66.4	100	266	ERBD	18
Wig 1999^[13]	40	61.8	60	386	PTBD	42.5
田伏洲2006^[14]	183	50	100	279	PTBD	21
Van der Gaag 2010^[15]	196	64.7	92	154	ERBD	36.4

第一作者及发表年	随机分配方法	隐藏分组	撤出、退出及意向性分析	Jadad评分
Hatfield 1982^[11]	1	1	1	3
McPherson 1984^[5]	1	1	0	2
Pitt 1985^[6]	2	1	1	4
Lai 1994^[12]	1	2	0	3
Wig 1999^[13]	1	1	0	2
田伏洲2006^[14]	1	1	0	2
Van der Gaag 2010^[15]	2	1	1	4

第一作者及发表年	随机分配方法	隐藏分组	撤出、退出及意向性分析	Jadad评分
Hatfield 1982^[11]	1	1	1	3
McPherson 1984^[5]	1	1	0	2
Pitt 1985^[6]	2	1	1	4
Lai 1994^[12]	1	2	0	3
Wig 1999^[13]	1	1	0	2
田伏洲2006^[14]	1	1	0	2
Van der Gaag 2010^[15]	2	1	1	4

[1]	Guangyu Yang, Lu Wang, Yu Wang, Chi Zhang, Jun Zeng, Hua Jiang, Mingwei Sun. Effect of intravenous omega-3 fatty acids on outcome of patients with sepsis: a systematic review and meta-analysis [J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2023, 18(02): 148-156.
[2]	Zongkai Lyu, Yangcan Zheng, Shengnan Du, Yingyang Yang. Efficacy of Nd: YAG laser in the treatment of oral lichen planus: A Meta-analysis [J]. Chinese Journal of Stomatological Research(Electronic Edition), 2022, 16(02): 100-105.
[3]	Qiang Wei, Mingxiang Zhang, Qiangpu Chen, Baofang Sun. Effect of modified xiaochengqi decoction on the gastrointestinal motility of rats with obstructive jaundice [J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(04): 267-270.
[4]	Qinglei Han, Mingjie Song, Jialong Li, Yingmei Shao. Effect of different biliary drainage before pancreaticoduodenectomy on postoperative complications [J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(02): 144-147.
[5]	Dianbao Yuan, Minghui Zhai, Na Wu, Huibin Gao. Endoscopic ultrasonography-guided gallbladder drainage in the treatment of low malignant obstructive jaundice: An animal experimental study [J]. Chinese Archives of General Surgery(Electronic Edition), 2022, 16(06): 412-416.
[6]	Peizhong Shang, Runping Zhang, Wei Zhang, Guohong Jia, Xiaowu Li, Jianjun Miao, Bing Liu. Clinical application of novel techniques for obstructive jaundice prevention and treatment: a single-center study [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 104-107.
[7]	Jijun Shan, Xiangcheng Li. Preoperative biliary drainage of hilar cholangiocarcinoma and its influence on safety of surgery [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(02): 157-161.
[8]	Jianping Gao, Shuang Li, Zhen Sun, Bing Qi, Qingkai Zhang, Guixin Zhang, Dong Shang. Value of preoperative reduction of jaundice in pancreaticoduodenectomy for moderate malignant obstructive jaundice [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(04): 381-385.
[9]	Shaohong Chen, Yongfu Li, Gangfeng Luo, Xuanzhang Huang, Li Gong, Xianxin Yan, Min Ma. A meta-analysis of the clinical effect of RPH combined with MMH versus that of PPH in the treatment of severe mixed hemorrhoids [J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2021, 10(06): 621-630.
[10]	Hui Fang, Fei Li, Fan Zhang, Qiang Wei, Qiangpu Chen. Effect of exogenous leptin on intestinal mucosal proliferation in rats with obstructive jaundice [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(05): 575-580.
[11]	Na Zhao, Jian Feng, Yue Bian, Wenjie Bi, Jing Zhang, Chenglin Piao, Xin Lan, Qiang Li, Jianjun Leng. Effect of care bundles on compliance to oral bile reinfusion in patients undergoing percutaneous transhepatic cholangial drainage and its clinical significantce [J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(08): 782-786.
[12]	Haibo Dang, Bo Qiao, Tongtong Guo, Chang Sun, Xiangfang Chen. Blood-letting puncture and cupping at back-shu points for the treatment of acne vulgaris: a network Meta-analysis of randomized controlled trials [J]. Chinese Journal of Acupuncture and Moxibustion(Electronic Edition), 2023, 12(02): 74-82.
[13]	Qin Li, Wei Mo, Xiuchun Yang, Yulian Li, Bifang Zhou. Qualitative study of family caregivers' care experience after PTBD in patients with malignant obstructive jaundice [J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2022, 10(04): 451-455.
[14]	Linyan Lou, Lizhou Wang, Shi Zhou, Tianpeng Jiang, Dongniang Lei, Xing Zheng. Obstructive jaundice after PTCD with infection: analysis of multiple factors [J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2022, 10(03): 306-311.
[15]	Guofeng Wang, Yuan Hui, Fengli Wang, YongXin Yan. Meta analysis of the effect of bariatric surgery on thyroid function and the dose of Levothyroxine replacement therapy in obesity patients with hypothyroidism [J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2022, 08(04): 263-270.

Please choose a citation manager

Content to export