A Meta Analysis On The Preoperative Biliary Drainage Comparison Of PTCD And EBD Of Hilar Cholangiocarcinoma

Objective:To compare the efficacy and safety of preoperative biliary drainage of PTCD and EBD of hilar cholangiocarcinoma.Methods:The randomized controlled trials from PubMed database(from January 1966 to January 2018),EMBASE database(from January 1988 to January 2018),Cochrane library,CKNI(from January 1966 to January 2018),Weip(from January 1966 to January 2018)were retrieved,evaluated the included literatures according to the bias risk review tool recommended by Cohchrane system commentator manual(version 5.1),extracted the required data,and then performed meta-analysis on the target data.Analyzed the results using fixed or random effect models accroding to the heterogeneity test.Results:A total of 14 literatures,including 1666 cases of patients,were retrieved to meet the inclusion criteria.The Meta analysis results showed that: the analysis using random or fixed effect model showed that,in the preoperative biliary drainage success rate of hilar cholangiocarcinoma,the PTCD group was significantly higher than that of the EBD group(RR=1.21,95%CI[1.14,1.29]),and the biliary tract infection rate(RR=0.54,95%CI[0.35,0.84];P < 0.006),the incidence of pancreatitis(RR=0.27,95%CI[0.14,0.51],P < 0.0001)were less than those of ERCP group,but in the bleeding rate,the PTCD group was higher than that of EBD group RR=4.23,? 95% CI[2.31,7.76];P <0.0001),and the difference was statistically significant.The PTCD has a higher risk of tumor dissemination.In the EBD group,there were no significant differences in the biliary tract infection rate(RR=1.10,95%CI[0.79,1.53],P=0.56)and incidence of pancreatitis(RR=1.62,95%CI[0.76,3.47],P=0.21)between the EBS and ENBD.Conclusion:The safety and efficacy of preoperative biliary drainage of hilar cholangiocarcinoma in PTCD group were better than those in EBD groupa.Although PTCD group has higher the risk of bleeding and tumor spread on preoperative biliary drainage of hilar cholangiocarcinoma.,the success rate of yellowing,cholangitis and pancreatitis were superior to EBD,especially in the application of III and IV type of hilar cholangiocarcinoma.And the EBD could also be used as a safe alternative means in type I and partial type II hilar cholangiocarcinoma.In the preoperative biliary drainage of hilar cholangiocarcinoma,the use of PTCD or EBD should be based on the technical level of different medical centers and the specific situation of the patients.The results of this study needed to be further demonstrated by more randomized controlled trials.