Safety and efficacy of three-dimensional reconstruction technology-assisted percutaneous transhepatic biliary drainage: A meta-analysis

Abstract

Background: Percutaneous transhepatic biliary drainage (PTBD) is one of the primary clinical treatment options for patients with obstructive jaundice. In recent years, PTBD assisted by three-dimensional (3D) reconstruction technology has been widely implemented, but its advantages over traditional methods remains inconclusive. Thus, a discussion is warranted.

Aim: To explore the safety and efficacy of 3D reconstruction technology-assisted PTBD.

Methods: We systematically searched the databases including the Cochrane Library, PubMed, EMBASE, Web of Science and China National Knowledge Infrastructure. The search period extended from the establishment of each database to November, 2024. We screened the literature according to predefined inclusion and exclusion criteria, assessed the quality of the studies, and extracted data. Meta-analysis was performed using Revman 5.4.1 software.

Results: A total of 15 studies were included, involving 1434 patients. The results of the meta-analysis showed that compared with the traditional group, the overall post-operative complications rate in the 3D reconstruction technology group was significantly lower [odds ratio = 0.25; 95% confidence interval (CI): 0.17-0.36, P < 0.00001]. The overall puncture success rate in the 3D reconstruction group was better than those in the traditional group (odds ratio = 3.61; 95%CI: 1.98-6.55, P < 0.0001). However, there was no significant difference between the two groups in the reduction levels of postoperative total bilirubin (mean difference = -1.38; 95%CI: -3.29 to 0.53, P = 0.16). Subgroup analysis were conducted on the surgery time according to guidance stages of the 3D reconstruction, 3D reconstruction imaging modalities, and types of studies. The results were stable, with no significant changes observed.

Conclusion: 3D reconstruction technology significantly improves the puncture success rate and safety of PTBD. However, it has no significant advantage in bile drainage effectiveness. Continued research is warranted to further explore its clinical value and optimize its application.

Keywords: Complications; Liver function; Obstructive jaundice; Percutaneous transhepatic biliary drainage; Three-dimensional reconstruction technology.

Figure 1

Flow chart of article screening.

Figure 2

Article quality evaluation chart: Randomized controlled trials.

Figure 3

Meta-analyses of surgical and postoperative outcomes (including operation time, puncture-related indicators, and postoperative complications). A: Meta-analysis of operation time; B: Meta-analysis of number of punctures; C: Meta-analysis of first puncture success rate; D: Meta-analysis of overall puncture success rate; E: Meta-analysis of post-operative bleeding; F: Meta-analysis of biliary fistula; G: Meta-analysis of postoperative infection; H: Meta-analysis of overall post-operative complications rate; I: Meta-analysis of the reduction levels of postoperative total bilirubin. 3D: Three-dimensional; CI: Confidence interval.

Figure 4

Meta-analysis of the reduction levels of aspartate transaminase and alanine transaminase. A: Meta-analysis of the reduction levels of aspartate transaminase; B: Meta-analysis of the reduction levels of alanine transaminase. 3D: Three-dimensional; CI: Confidence interval.

Figure 5

Meta-analysis for subgroup analysis of surgery time. A: Meta-analysis for subgroup analysis of surgery time according to guidance stages of the three-dimensional reconstruction; B: Meta-analysis for subgroup analysis of surgery time according to three-dimensional reconstruction imaging modalities; C: Meta-analysis for subgroup analysis of surgery time according to types of studies. CI: Confidence interval.

Figure 6

Funnel plot based on overall post-operative complications rate. OR: Odds ratio.