Comparison of Clinical Effects about Hilar Cholangiocarcinoma Operation of Patients after Preoperative Biliary Drainage by EBD and PTBD
ZHOU Quan-yu,LEI Ze-hua,DU-bo
Abstract:
Objective To compare the effect of preoperative endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage (PTBD) in patients with hilar cholangiocarcinoma(HCCA). Methods 112 cases of HCCA patients admitted to our hospital from January 1, 2013 to December 31, 2018 were included in the study. Among them, 65 cases received PTBD drainage and 47 cases received EBD drainage. The effects,complications and effects of two drainage methods were compared. Results There were no significant differences in age, gender, serum bilirubin peak level before drainage, combined with hypertension, diabetes,cirrhosis and other general pathological features between the two groups. In 65 patients with PTBD group, 39(60%) were successfully drained with the first intubation, while in 47 patients with EBD group, 27 (57.4%) were successfully drained with the first intubation. The total incidence of complications after drainage in EBD group(53.1%, 25/47) was higher than that in PTBD group (24.6%, 16/65), which the difference was statistically significant (χ2=9.594, P =0.019). Compared with the EBD group, the PTBD group had better biliary drainage effect (t =3.264, P =0.001). The most common complications in PTBD group were drainage tube detachment,followed by cholangitis and drainage tube blockage.The most common complication in EBD group was cholangitis, followed by pancreatitis and hemorrhage.The incidence of cholangitis and pancreatitis in EBD group was higher than that in PTBD group (P<0.05). There was no signi?cant difference between the two groups (P>0.05). The difference in tumor recurrence rate between the two groups was statistically significant (HR=0.452, 95%CI: 0.267-0.766, P=0.003). Median survival time was not statistically significant (HR=0.975, 95% CI: 0.617-1.540, P=0.914). Conclusion Preoperative biliary drainage in HCCA patients with EBD and PTBD can achieve ideal efficacy. However, PTBD has a higher success rate of drainage and fewer complications in patients with hilum cholangiocarcinoma, which is more valuable for promotion in primary medical institutions. However, PTBD has the disadvantage of tumor spreading along the duct, which should be paid attention to in the application process.
