| Objective:Meta-analysis of clinical studies on palliative ENBD and PTCD for advanced HCCA published at home and abroad was performed in order to evaluate and compare the efficacy and safety of ENBD and PTCD for advanced HCCA.Methods:The relevant literatures on palliative PTCD and ENBD for advanced HCCA clinical trials were searched in Chinese and English databases such as China National Knowledge Infrastructure(CNKI),Wanfang database,VIP database,Chinese Biomedical Literature Database(CBM),Pub Med,Embase,Cochrane and Web of Science.Two investigators independently screened the literatures.The quality evaluation of the included literatures was completed using NOS scale.The relevant data of success rate of biliary drainage operation,TBIL change after biliary drainage,acute pancreatitis after biliary drainage,biliary tract infection,hemobilia and other complications,and patient survival after biliary drainage were extracted.Rev Man 5.3 software was used for data analysis.Results:Through a comprehensive search of the database,according to the inclusion criteria and exclusion criteria,25 articles were finally included in this study.Results Analysis showed that the operation success rate of PTCD was higher than that of ENBD(OR =0.40,95% CI:(0.30 ～ 0.53),Z = 6.26,P < 0.00001);there was no significant difference between ENBD and PTCD in TBIL change after biliary drainage(SMD = 0.08,95% CI:(-0.03 ～ 0.18),Z = 1.47,P = 0.14 > 0.05);in terms of postoperative complications,the incidence of acute pancreatitis after ENBD drainage was higher than that of PTCD(OR= 5.81,95% CI:(3.16 ～ 10.67),Z = 5.66,P < 0.00001),the incidence of biliary tract infection after ENBD drainage was higher than that of PTCD(OR = 3.13,95% CI:(2.32～ 4.21),Z = 7.48,P < 0.00001),the incidence of hemobilia after ENBD drainage was lower than that of PTCD(OR = 0.35,95% CI:(0.24 ～ 0.52),Z = 5.25,P < 0.00001);the survival time of ENBD after biliary drainage was higher than that of PTCD(OR = 0.40,95% CI: 0.21 ～ 0.59)Z = 4.11,P < 0.0001).Conclusion:Both ENBD and PTCD can be used as options for palliative jaundice reduction in advanced HCCA obstructive jaundice,and each has its own advantages and disadvantages.PTCD was superior to ENBD in terms of drainage success rate,complications such as acute pancreatitis and biliary tract infection;ENBD was superior to PTCD in terms of hemobilia after drainage and patient survival;there was no significant difference in TBIL changes between ENBD and PTCD after drainage. |
