吲哚菁绿荧光成像引导腹腔镜肝脏肿瘤切除术安全性和有效性的荟萃分析

Meta analysis of indocyanine green fluorescence imaging guided laparoscopic liver tumor resection

目的系统评价吲哚菁绿荧光成像引导腹腔镜肝脏肿瘤切除术(FIGLTR)的短期效果与安全性。方法以吲哚菁绿、荧光成像、腹腔镜、肝脏肿瘤、肝脏切除术、indocyanine green、fluorescence imaging、laparoscopic、liver tumor、hepatectomy为检索词,在PubMed、Web of Science、Embase、Cochrane Library、中国生物医学文献数据库、中国知网数据库、万方数据库和维普数据库进行文献检索。检索时间为建库至2021年9月30日。在对纳入研究进行方法学质量评价后,采用Review Manager 5.1软件对总体结果进行荟萃分析。结果经筛选后共纳入10篇文献,803例患者,其中FIGLTR组341例,非FIGLTR组462例。本荟萃分析纳入文献质量均较高。荟萃分析结果发现,与非FIGLTR组相比,FIGLTR组的手术时间(MD=-22.61,95%CI:-34.20~-11.03,P<0.001)、术中出血量(MD=-49.17,95%CI:-84.99~-13.36,P<0.01)、住院时间(MD=-0.89,95%CI:-7.72~-0.06,P<0.05)、术后并发症发生率(OR=0.55,95%CI:0.34~0.87,P<0.05)均减少,R0切缘率(OR=8.80,95%CI:1.96~39.44,P<0.05)增加。但两组在肝门阻断时间和输血率的比较上,差异没有统计学意义(P>0.05)。结论吲哚菁绿荧光成像技术为腹腔镜肝脏肿瘤精准切除提供了新途径,安全可行。

Objective This meta-analysis was conducted to systematically evaluate the short-term efficacy and safety of indocyanine green fluorescence imaging guided laparoscopic liver tumor resection(FIGLTR).Methods A systematic search was made for the literature on indocyanine green fluorescence image-guided laparoscopic hepatectomy in randomized,semi-randomized controlled trials and observational studies,and manually search published materials and conference papers in Chinese and English and trace references included in the literature.The retrieval period was up to September 2021.The quality of included studies was evaluated,then the meta-analysis was conducted using Review Manager 5.1 software.Results Ten studies were included with 803 patients,including 341 in the FIGLTR group and 462 in the non-FIGLTR group.Meta results showed that:Compared to the traditional resection group,indocyanine green fluorescence imaging can significantly shorten the operative time(MD=-22.61,95%CI:-34.20--11.03,P<0.001),reduce intraoperative bleeding(MD=-49.17,95%CI:-84.99--13.36,P<0.01),shorter hospital stay(MD=-0.89,95%CI:-7.72--0.06,P<0.05),Improve the removal rate of R0 edge(OR=8.80,95%CI:1.96-39.44,P<0.05)and reduce the incidence of postoperative complications(OR=0.55,95%CI:0.34-0.87,P<0.05)of laparoscopic liver tumor resection.There were no differences found in portal block time and transfusion rate.Conclusion Indocyanine green fluorescence imaging technology provides a new way for safe and accurate laparoscopic resection of liver tumors.