肝门部胆管癌患者术前不同胆道引流方式的Meta分析  

Selection of the best preoperative biliary drainage method for patients with hilar cholangiocarcino-ma:a Meta-analysis

作　　者：王云检 尤国华 张璐阳 张珉 Wang Yunfian;You Guohua;Zhang Luyang;Zhang Min(Department of Hepatobiliary and Pancreatic Surgery,Affiliated Tumor Hospital of Zhengzhou University (Henan Cancer Hospital),Zheng- zhou,Henan 450008,China)

机构地区：[1]郑州大学附属肿瘤医院河南省肿瘤医院肝胆胰外科,郑州450008

出　　处：《中华肝胆外科杂志》2018年第12期818-822,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：:国家自然科学基金联合基金(U1404820);河南省重点科技攻关项目(142102310438).

摘　　要：目的探讨肝门部胆管癌患者术前胆道引流(PBD)的最佳方式。方法通过PubMed、EMBASE、webofScience、CNKI和万方数据库系统搜索肝门部胆管癌患者PBD的前瞻性或回顾性研究,对引流相关性胆管炎、胰腺炎、出血以及胆汁淤积缓解成功率进行Meta分析。结果纳入12篇相关文献,共1567例患者。分析结果显示,与内镜胆道引流(EBD)相比,经皮经肝胆道引流(PTBD)并发胆管炎风险低(RR=0.60,95%CI:0.39~0.95,P<O.05),胰腺炎发生风险低(RR=0.30,95%CI:0.15~0.59,P<0.05),缓解胆汁淤积成功率高(RR=2.77,95%CI:1.79—4.28,P<0.05)。但PTBD出血风险(RR=2.38,95%CI:1.12~5.05,P<0.05),术中输血风险(RR=1.59,95%CI:1.05~2.42,P<0.05)及腹腔转移风险较高(RR:3.24,95%CI:1.15—9.12,P<0.05)。且PTBD腹腔转移发生率高达4.2%。PTBD与EBD在胆漏、腹腔内脓肿、R0切除、术后住院时间、术后并发症、患者院内病死率等方面差异无统计学意义(P>0.05)。ENBD与EBS相比,胆管炎、胰腺炎、肝脓肿发生率无明显差异。结论肝门部胆管癌患者需要进行PBD时,应首选内镜下鼻胆管引流(ENBD)。PTBD可以作为ENBD引流失败后的补救措施。Objective To select the best preoperative biliary drainage (PBD)method for patients with hilar cholangiocarcinoma.Methods The PubMed,EMBASE,Web of Science,CNKI,and Wanfang Database were systematically searched for prospective or retrospective studies on biliary drainage for patients with hilar cholangiocarcinoma with obstructive jaundice.The drainage-related cholangitis,pancreatitis,hemorrhage,and the success rate in relieving jaundice were analyzed.The meta-analysis was performed using the Review Manager 5.3 and the stata 12.0using a fixed or random effects model.Results This meta-analysis included 12studies with 1567patients.The results showed a lower risk of cholangitis with PTBD than EBD (RR=0.60,95%CI:0.39-0.95,P<0.05).PTBD also resulted in a lower risk of pancreatitis than EBD (RR=0.30,95%CI:0.15~0.59,P<0.05),and a higher rate of successful relief of cholestatic jaundice (RR=2.77,95%CI:1.79-4.28,P<0.05).However,the risk of bleeding for PTBD was higher (RR=2.38, 95%CI:1.12-5.05,P<0.05),the risk of intraoperative blood transfusion increased (RR=1.59,95%CI: 1.05-2.42,P<0.05),and the risk of celiac metastasis was also increased (RR=3.24,95%CI:1.15- 9.12,P<0.05)when compared with EBD.The incidence of celiac metastasis was as high as 4.2%.There were no significant differences between PTBD and EBD in the rates of bile leakage,intra-abdominal abscesses,hemorrhage,R0resection,postoperative hospital stay postoperative complications and in-hospital mortality,what's more,there were no significant differences in the incidence of cholangitis,pancreatitis,and liver abscess between ENBD and EBS.Conclusions The postoperative hospital stay was similar between the two groups.ENBD was a better choice than PTBD for patients who required PBD.PTBD could be used after the failure of ENBD.

关 键 词：内镜胆道引流 经皮经肝胆道引流 肝门部胆管癌 KLATSKIN瘤 荟萃分析 

分 类 号：R735.8[医药卫生—肿瘤]