| Objective: To determine the benefits and harms of preoperative biliary drainage (PBD) in malignant obstructive jaundice.?Methods: We searched the Cochrane Library, PubMed, EMBASE, Chinese Biomedical Literature Database (all up to June 2010) added with handsearching and other retrievals to collect all the randomized controlled trials (RCT) comparing preoperative biliary drainage followed by surgery and direct surgery performed for malignant obstructive jaundice.?After that,all the included RCTs undergo quality evaluation on methodology and Meta- analysis recommended by the Cochrane Website.Results: Seven trials with 698 patients were included.two trials were high quality(Jadad's score>4),whereas five trials were low quality(Jadad's score <4).?Meta-analysis showed no significant difference of mortality (P=0.88) between PBD group and controlled group.Lower postoperative morbidity(OR=0.49,95% CI=0.31~0.79)and overall morbidity(OR=0.34,95%CI =0.16~ 0.71),the posterior of which was result from recent researches, were found in percutaneous transhepatic biliary drainage (PTBD) group.However,higher overall morbidity(OR=2.80,95% CI=1.11~7.04) was observed in endoscopic retrograde biliary drainage (ERBD) group.Prognosis was improved in younger patients(OR=0.34,95% CI=0.16~0.71) with severe jaundice(OR =0.56,95% CI =0.37~0.84)and biliary drainage less than four weeks(OR=0.60,95% CI=0.39~0.93).Conclusion: Selecting the appropriate candidate, taking appropriate type of drainage, controlling appropriate drainage time, PBD could decrease postoperative morbidity and even overall morbidity of malignant obstructive jaundice but has no significant beneficial effect on mortality.?... |
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