The Value Of Preoperative Biliary Drainage For Resectable Hilar Cholangiocarcinoma:the Meta Analysis

Objective: to discuss the value of preoperative biliary drainage in patients with resectable hilar cholangiocarcinoma through systematic evaluation and quantitative analysis.Methods: We searched all relevant documents published in English databases Pubmed,Cochrane Library,Embase and Chinese databases CNKI,Wanfang Database,and China Biology Medicine disc(CBM).The search time was limited from January1,2000 to October 1,2020.The Meta analysis of each outcome index was carried out by Stata11 software.Results: Respectively 25 and 10 original studies were included in the 2 meta-analysis.The first part of the results indicated that there was no significant difference in the incidence of postoperative total complications(RR=1.03,95%CI0.94-1.13,P=0.504)between the PBD group and the NPBD group.There was no significant difference in the perioperative mortality(RR=0.97,95%CI0.54-1.73,P=0.907)between the two groups,and no significant difference in the mortality within 90 days after operation(RR=0.73,95%CI0.45-1.17,P=0.186).The incidence of postoperative hepatic insufficiency in the PBD group of HCCA patients was low(RR=0.53,95%CI0.38-0.75,P<0.001),the risk of hemobilia(RR=3.74,95%CI 1.30-10.80,P=0.015)and pancreatitis(RR=3.89,95%CI1.02-14.89,P=0.047)after treatment was high,and the hospital stay(SWD=0.78,95%CI0.59-0.97,P<0.001)was long.There was no significant difference in the rate of radical resection(P=0.548),the risk of postoperative incision infection(P=0.878),the risk of postoperative abdominal infection(P=0.997),the incidence of postoperative sepsis(P=0.563),and the incidence of postoperative bile leakage(P=0.700)between the two groups.There was no significant difference in the incidence of upper gastrointestinal bleeding(P=0.190)and intra-abdominal hemorrhage(P=0.464).There was no significant difference in the amount of intraoperative blood loss(P=0.296),the duration of operation(P=0.940)and the length of postoperative hospital stay(P=0.580).The second part of the results suggested that the risk of pancreatitis(RR=0.12,95%CI0.05-0.29,P<0.001),the incidence of drainage-related complications(RR=0.51,95%CI0.36-0.71,P<0.001)and the conversion rate(RR=0.13,95%CI0.07=0.25,P<0.001)of drainage methods after EBD treatment were significantly higher than those in the PTBD group.There were no significant differences in cholangitis(P=0.296),bleeding(P=0.415)and postoperative complications(P=0.710)between the two groups.Conclusion: PBD can reduce the risk of postoperative hepatic insufficiency in HCCA patients.However,due to the risk of bleeding and pancreatitis in the PBD operation itself,the length of hospital stay is prolonged.It is recommended that the PBD of patients with resectable HCCA should be performed in a center with certain operating experience and technology.Compared with EBD,PTBD has a lower incidence of drainage-related complications and pancreatitis,and a lower conversion rate of drainage methods.It is recommended that PTBD be the preferred method of preoperative biliary drainage for patients with resectable HCCA.Bilirubin level is not the only indication of PBD.The presence or absence of liver cirrhosis,active hepatitis,malnutrition caused by high bilirubin,biliary obstruction time and future remant liver can be used as the timing of PBD,and the serum for PBD implementation The critical point of total bilirubin showed a downward trend.