三维可视化技术与二维影像比较辅助肝切除术临床效果的Meta分析

Application of three-dimensional visualization technique vs. two-dimensional imaging technique in hepatectomy: a meta-analysis

目的系统评价三维可视化技术与二维影像辅助肝切除术的临床效果。方法计算机检索EMbase、Pub Med、The Cochrane Library、CBM、CNKI、Wan Fang Data和VIP数据库,搜集国内外公开发表的有关三维可视化技术与二维影像辅助肝切除术比较的临床研究,检索时限均从建库至2017年9月。由2名研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果共纳入11个临床研究,其中7个队列研究、3个自身对照试验和1个非同期对照试验,包括953例患者。Meta分析结果显示,与传统二维影像技术相比,三维可视化技术可提高根治性手术切除率(R0切除率)[OR=2.91,95%CI(1.31,6.43),P=0.009]、降低术后并发症发生率[OR=0.55,95%CI(0.38,0.80),P=0.002]、减少术中输血量[MD=–96.05,95%CI(–126.78,–65.31),P<0.000 01]、减少术前预测切除体积与术中实际切除体积之间的偏差[MD=–94.38,95%CI(–185.46,–3.30),P=0.04]、缩短手术时间[MD=–33.58,95%CI(–60.09,–7.08),P=0.01]和减少术中出血量[MD=–79.70,95%CI(–139.86,–19.53),P=0.009]。但两组住院时间[MD=–0.75,95%CI(–2.45,0.95),P=0.39]的差异无统计学意义。结论当前证据显示,应用三维可视化技术辅助肝切除术,可更好预测肝脏肿瘤切除体积、提高肝脏肿瘤R0切除率、缩短手术时间、减少术中输血量及出血量、减少术后并发症发生。受纳入研究数量和质量的限制,上述结论尚待开展更多高质量研究予以验证。

Objectives To systematically review the clinical efficacy of three-dimensional （3D） visualization vs. two-dimensional （2D） imaging technique in hepatectomy. Methods PubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect clinical trials which compared 3D visualization with conventional 2D imaging technique for hepatectomy from inception to September 2017. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies, and then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 1I studies involving 953 patients were included. The results of meta-analysis showed that： compared to 2D imaging technique, 3D visualization technique could improve R0 resection rate （OR=2.91, 95%CI 1.31 to 6.43, P=0.009）, had lower incidence of postoperative complication （OR=0.55, 95%CI 0.38 to 0.80, P：0.002）, less amount of blood transfusion in operation （MD=-96.05, 95%CI -126.78 to -65.31, P〈0.000 01）, lower discrepancy range between the volume of the predicted liver resection and actual resection volume （MD=-94.38, 95%CI -185.46 to -3.30, P=0.04）, shorter operation time （MD=-33.58, 95%CI -60.09 to -7.08, P=0.01）, and lower intraoperative blood loss （MD=-79.70, 95%CI -139.86 to -19.53, P=0.O09）, the differences were statistically significant. There were no statistical differences between two groups in postoperative hospital stay time （MD=-0.75, 95%CI -2.45 to 0.95, P=0.39）. Conclusions The current evidence shows that application of 3D visualization techniquein hepatectomy can predict the liver resection volume more accurately, improve the Ro resection rate, shorten operation time, decrease intraoperative blood transfusion volume and the amount of bleeding, and reduce the incidence of postoperative complications. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusion.