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.

ObjectiveTo investigate the safety and efficacy of laparoscopic splenectomy (LS) in patients with hepatitis B virus (HBV)-related cirrhotic, portal hypertension and splenomegaly.Methods Clinical data of 10 patients with HBV-related cirrhotic, portal hypertension and splenomegaly undergoing LS in 105th Hospital of Chinese People's Liberation Army between September 2008 and December 2014 were retrospectively analyzed. Among the patients, 4 were males and 6 were females, with the age ranging from 28 to 65 years old and the median of 48 years old. One case was with mild splenomegaly and 9 were with moderate splenomegaly. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients received conventional LS by 4-port approach. The perioperative conditions and complications were observed.ResultsLS was successfully performed on all the patients. Seven cases underwent simple LS, 2 underwent LS + cholecystectomy, and 1 underwent LS + portal-azygous disconnection. The operation duration was 245 (180-325) min, the intraoperative blood loss was 200 (20-800) ml, the intraoperation blood transfusion rate was 5/10 and the incidence of complications was 8/10. One case died of disseminated intravascular coagulation, and other patients discharged after recovery. ConclusionLS is safe and effective for patients with HBV-related cirrhotic, portal hypertension and splenomegaly.