胰腺癌患者胰十二指肠切除术前的最佳术前胆道引流尚不清楚。本研究旨在比较金属支架（MS）和塑料支架（PS）的疗效和安全性。使用MEDLINE和Web of Science系统检索了胰十二指肠切除术前使用MS和PS治疗胰腺癌的比较研究数据库。还提取了术前和术后数据。进行随机效应荟萃分析，比较内镜逆行胰胆管造影（ERCP）术后并发症以及研究两组之间的术中和术后结果，并计算汇总比值比（OR）或平均差（MD）置信区间 (CI) 为 95%。该研究分析了涉及 683 名患者的 12 项研究。插入 MS 与较低的再干预发生率相关（OR，0.06；95% CI 0.03-0.15；P < 0.001），增加 ERCP 后不良事件的发生率（OR，2.22；95% CI 1.13-4.36；P = 0.02），相似的手术时间（MD，18.0 分钟；95% CI -29.1 至 65.6 分钟；P = 0.46）、失血量（MD，43.0 ml；95% CI -207.1 至 288.2 ml；P = 0.73）和手术并发症发生率（OR，0.78；95% CI 0.53-1.15；P = 0.21）。 MS组3个月后的累积支架通畅率高于PS组（70-100% vs 30.0-45.0%）。在这个多学科治疗时代，对于胰腺癌患者的胆道引流，MS的使用可能是首选，因为与 PS 相比，MS 提供更持久的胆道引流，并且术后结果的风险相似。© 2023。外科肿瘤学会。

Optimal preoperative biliary drainage for patients with pancreatic cancer before pancreatoduodenectomy remains unclear. This study aimed to investigate the comparison of efficacy and safety between a metallic stent (MS) and a plastic stent (PS).Comparative studies on the use of MS and PS for pancreatic cancer before pancreatoduodenectomy were systematically searched using the MEDLINE and Web of Science databases. Pre- and postoperative data also were extracted. Random-effects meta-analyses were performed to compare post-endoscopic retrograde cholangiopancreatography (ERCP) complications as well as intra- and postoperative outcomes between the two arms of the study, and pooled odds ratios (ORs) or mean differences (MDs) were calculated with 95 percent confidence intervals (CIs).The study analyzed 12 studies involving 683 patients. Insertion of MS was associated with a lower incidence of re-intervention (OR, 0.06; 95% CI 0.03-0.15; P < 0.001), increased post-ERCP adverse events (OR, 2.22; 95% CI 1.13-4.36; P = 0.02), and similar operation time (MD, 18.0 min; 95% CI -29.1 to 65.6 min; P = 0.46), amount of blood loss (MD, 43.0 ml; 95% CI -207.1 to 288.2 ml; P = 0.73), and surgical complication rate (OR, 0.78; 95% CI 0.53-1.15; P = 0.21). The cumulative stent patency rate after 3 months was higher in the MS group than in the PS group (70-100 % vs 30.0-45.0 %).For biliary drainage in patients with pancreatic cancer during this era of multidisciplinary treatment, MS use might be the first choice because MS provides a more durable biliary drainage and a similar risk of postoperative outcomes compared with PS.© 2023. Society of Surgical Oncology.