Wang Lei, Lin Nanping, Xin Fuli, Zeng Yongyi, Liu Jingfeng
Department of Radiation Oncology; The United Innovation of Mengchao Hepatobiliary Technology Key Laboratory of Fujian Province, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China.
The United Innovation of Mengchao Hepatobiliary Technology Key Laboratory of Fujian Province; Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University; Liver Diseases Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
Saudi J Gastroenterol. 2019 Mar-Apr;25(2):81-88. doi: 10.4103/sjg.SJG_429_18.
BACKGROUND/AIM: For resectable extrahepatic cholangiocarcinoma with biliary obstruction, it remains a controversy whether to choose percutaneous transhepatic biliary drainage (PTBD) or endoscopic biliary drainage (EBD). A systematic review was conducted to compare the long-term efficacy between the two techniques.
Eligible studies were searched from January 1990 to May 2018, comparing the long-term efficacy between EBD and PTBD for extrahepatic cholangiocarcinoma. Primary end point was overall survival (OS) rate, and secondary end points included postoperative severe complications and seeding metastasis. Effect size on outcomes was calculated using a fixed- or random-effect model, accompanied with hazard ratio (HR) and 95% confidence interval (CI).
Six studies were included in this meta-analysis. Meta-analysis showed that EBD was superior to PTBD in OS (HR = 0.70, 95% CI 0.59-0.84,P= 0.0002). But subgroup results showed that the superiority disappeared in distal cholangiocarcinoma (HR = 0.76, 95% CI 0.56-1.01,P= 0.06). Other prognostic factors such as intraoperative blood transfusion, lymphatic metastasis and seeding metastasis, were inconsistent between groups. In addition, regional disparity was obviously apparent between Japanese and non-Japanese studies.
The conclusion that EBD was superior to PTBD in OS for resectable extrahepatic cholangiocarcinoma with biliary obstruction is less convincing, and more trials need to be conducted in future.
背景/目的：对于可切除的伴有胆道梗阻的肝外胆管癌，选择经皮经肝胆道引流（PTBD）还是内镜下胆道引流（EBD）仍存在争议。本研究进行系统评价以比较这两种技术的长期疗效。
检索1990年1月至2018年5月符合条件的研究，比较EBD和PTBD治疗肝外胆管癌的长期疗效。主要终点为总生存率（OS），次要终点包括术后严重并发症和种植转移。采用固定效应或随机效应模型计算结局的效应量，并伴有风险比（HR）和95%置信区间（CI）。
本荟萃分析纳入6项研究。荟萃分析显示，EBD在OS方面优于PTBD（HR = 0.70，95% CI 0.59 - 0.84，P = 0.0002）。但亚组结果显示，在远端胆管癌中这种优势消失（HR = 0.76，95% CI 0.56 - 1.01，P = 0.06）。其他预后因素如术中输血、淋巴结转移和种植转移，两组之间不一致。此外，日本和非日本研究之间存在明显的地区差异。
对于可切除的伴有胆道梗阻的肝外胆管癌，EBD在OS方面优于PTBD这一结论缺乏说服力，未来需要进行更多试验。
