Effect Of Different Preoperative Biliary Drainage Methods On Resectable Hilar Cholangiocarcinoma:A Meta Analysis

Aims: To evaluate the safety and efficacy of PTBD and EBD in preoperative biliary drainage of hilar cholangiocarcinoma patients.Methods: Keyword search Pubmed,Embass,Web of Science,CNKI,VIP,Wanfang and other databases to obtain different preoperative biliary drainage methods for the treatment of hilar cholangiocarcinoma.The search time was from January1998 to December 2018.Meta analysis was carried out with RevMan5.3 software.Results: A total of 1523 patients were enrolled in 10 studies.Meta analysis showed a high risk of cholangitis in the EBD group(OR=0.10,95%CI 0.03-0.34,P<0.00001).The risk of pancreatitis was higher(OR=2.67,95%CI 1.30-5.48,P=0.007)and total complications(OR = 0.48,95%CI 0.30-0.77,P=0.002),The risk of changing the drainage pattern is high(OR = 0.08,95%CI 0.04-0.15,P<0.00001).In PTBD group,the risk of bile duct translocation was higher(OR = 2.08,95%CI 1.06-4.10,P= 0.03),and the risk of tumor implantation and metastasis was higher(OR=2.67,95%CI 1.30-5.48,P<0.007).There was no significant difference in the risk of bleeding between the two groups(OR = 2.18,95%CI 0.24-19.89,P = 0.49),and there was no significant difference in the success rate of the first operation(OR=1.76,95%CI0.92-3.35,P=0.09).There was no significant difference in risk of postoperative complications(OR= 1.13,95%CI 0.79-1.61,P=0.51),and in-hospital mortality(OR =1.62,95%CI 0.76-3.46,P=0.21),and there was no significant difference in hospital mortality(OR=1.62,95%CI 0.76-3.46,P=0.21).Conclusions: Both EBD and PTBD have their own advantages and disadvantages.PTBD can reduce the risk of cholangitis and pancreatitis caused by operation,and the incidence of changing drainage mode is lower than that of EBD,toreduce the economic stress and pain of patients,but improper nursing can increase the risk of duct displacement.Although studies have shown that PTBD has a higher risk of implant metastasis than EBD,its impact on long-term survival remains controversial,The decision to use PTBD should not be affected by planting transfer.Therefore,preoperative biliary drainage for hilar cholangiocarcinoma may be the first choice for PTBD.