术前经内镜胆管引流术对比经皮胆管穿刺引流术治疗肝门部胆管癌的疗效和安全性Meta分析

doi:10.3969/j.issn.1004-583X.2018.06.016

临床荟萃

术前经内镜胆管引流术对比经皮胆管穿刺引流术治疗肝门部胆管癌的疗效和安全性Meta分析

庆阳市人民医院普通外科，甘肃庆阳 745000

出版日期:2018-06-05 发布日期:2018-06-25
通讯作者: 通信作者：张志峰, Email: zhifengzhangq@hotmail.com

Percutaneous transhepatic biliary drainage versus endoscopic biliary drainage for perihilar cholangiocarcinoma: a metaanalysis

Department of General Surgery, Qingyang People' Hospital, Qingyang, Gansu 745000, China

Online:2018-06-05 Published:2018-06-25
Contact: Corresponding author: Zhang Zhifeng, Email: zhifengzhangq@hotmail.com

摘要/Abstract

摘要： 目的比较术前经内镜胆管引流与经皮胆管穿刺引流术治疗肝门部胆管癌的有效性和安全性。方法计算机检索PubMed数据库、Cochrane图书馆、Embase数据库、CNKI数据库、万方数据库、中国生物医学文献数据库，均从建库开始至2017年4月。查找术前经内镜胆道引流（endoscopic biliary drainage, EBD）和经皮胆道引流（percutaneous transhepatic biliary drainage, PTBD）治疗肝门部胆管癌的临床研究，采用STATA 12.0进行Meta分析。结果共纳入8项临床研究，共涉及799例肝门部胆管癌患者。Meta分析结果显示，肝门部胆管癌患者术前EBD较PTBD在并发症发生率（OR=1.27, 95%CI=0.89~1.82, P=0.185）、死亡率（OR=0.45, 95%CI=0.13~1.58, P=0.212）及胆红素水平变化（SMD=-0.47, 95%CI=-1.11~0.17, P=0.149）方面差异无统计学意义，但EBD组首次操作失败率（OR=2.50, 95%CI=1.31~4.79, P=0.006）及引流方式转换率（OR=9.71, 95%CI=4.64~20.30, P=0.001）较PTBD组高，差异有统计学意义。结论肝门部胆管癌患者术前采用PTBD成功率高，安全可行。该结论还需进一步多中心、大样本的随机对照试验验证。

关键词: 胆管肿瘤, 经内镜胆管引流术, 经皮胆管引流术, Meta分析

Abstract: Objective To determine the best initial procedure for performing preoperative biliary drainage in patients with perihilar cholangiocarcinoma (PHCC).Methods PubMed, the Cochrane Library, Embase database, CNKI, CBM, Wanfang database were searched for all studies published until April 2017 comparing endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage (PTBD) for preoperative biliary drainage. A Metaanalysis was performed by using STATA 12.0 software.Results A total of 799 patients with PHCC were involved in the 8 studies .The rates of initial technical failure(OR=2.50, 95%CI=1.314.79, P=0.006) and conversion(OR=9.71, 95%CI=4.6420.30, P=0.001) were higher in EBD group than those in PTBD group. However, there are no significant differences in overall complication(OR=1.27, 95%CI=0.891.82, P=0.185), procedurerelated morbidity rate(OR=0.45, 95%CI=0.131.58, P=0.212), and bilirubin levels(SMD=-0.47, 95%CI=-1.110.17, P=0.149).Conclusion Compared to EBC, PTBD, with a lower rate of initial technical failure and conversion, is a better initial procedure for performing preoperative biliary drainage in PHCC.

Key words: bile duct neoplasms； endoscopic biliary drainage, percutaneous transhepatic biliary drainage

慕春红，冯金龙，刘少飞，马平安，张志峰. 术前经内镜胆管引流术对比经皮胆管穿刺引流术治疗肝门部胆管癌的疗效和安全性Meta分析[J]. 临床荟萃, doi: 10.3969/j.issn.1004-583X.2018.06.016.

Mu Chunhong, Feng Jinlong, Liu Shaofei, Ma Pingan, Zhang Zhifeng. Percutaneous transhepatic biliary drainage versus endoscopic biliary drainage for perihilar cholangiocarcinoma: a metaanalysis[J]. Clinical Focus, doi: 10.3969/j.issn.1004-583X.2018.06.016.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2018.06.016

https://huicui.hebmu.edu.cn/CN/Y2018/V33/I6/525

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术前经内镜胆管引流术对比经皮胆管穿刺引流术治疗肝门部胆管癌的疗效和安全性Meta分析

Percutaneous transhepatic biliary drainage versus endoscopic biliary drainage for perihilar cholangiocarcinoma: a metaanalysis

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