原发性肝癌三维可视化精准诊疗与二维成像技术疗效比较Meta分析

Three-dimensional visualization technology for precise diagnosis and treatment of primary liver cancer: A Meta-analysis

目的系统评价原发性肝癌(PLC)三维可视化技术(3DVT)精准诊疗的有效性及安全性。方法计算机检索国内外数据库,搜集关于3DVT在PLC精准诊疗应用的队列研究,检索时限均为从建库至2019年6月。由2名独立研究者筛选文献、提取资料和评价纳入研究的方法学质量后,采用RevMan 5.3软件进行Meta分析。结果共纳入8项研究,包括533例病人,其中3DVT组263例,二维(2D)成像组270例。Meta分析结果显示,与2D成像组比较,3DVT组手术出血量减少(MD=-76.00,95%CI-127.25^-24.74,P=0.004)、手术时间缩短(MD=-44.81,95%CI-64.64^-24.98,P<0.00001)、术后并发症发生率降低(OR=0.46,95%CI 0.28~0.77,P=0.003)、术后肝功能恢复指标血清白蛋白(ALB)提高(MD=1.89,95%CI 0.74~3.04,P=0.001)、住院时间缩短(MD=-2.47,95%CI-3.25^-1.68),P<0.00001)、术后随访半年至1年肝癌复发率降低(OR=0.44,95%CI 0.22~0.88,P=0.02)。但在术后肝功能恢复指标丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)以及术后随访半年至1年肝癌存活率方面,两组间差异均无统计学意义(P均>0.05)。结论 3DVT在PLC的精准诊疗应用是安全有效的,并且可以有效减少手术出血量和术后并发症发生率、加快术后肝功能恢复、缩短手术时间和住院时间、降低短期随访肝癌复发率。

Objective To systematically review the effectiveness and safety of three-dimensional visualization technology(3 DVT)for precise diagnosis and treatment of primary liver cancer(PLC).Methods The cohort studies regarding using3 DVT in precise diagnosis and treatment of PLC were collected by searching several national and international online databases.The retrieval time was from inception of the database to June 2019.Two reviewers independently screened the literatures,extracted data and evaluated the methodological quality of included studies.Then,meta-analysis was performed by using RevMan 5.3 software.Results A total of 8 studies were finally included involving 533 patients,with 263 cases in 3 DVT group and 270 in two-dimensional(2D)imaging group.The results of meta-analysis showed that in 3 DVT group,compared with 2 D imaging group,the intraoperative blood loss was reduced(MD=-76.00,95%CI-127.25—-24.74,P=0.004);the operative time was shortened(MD=-44.81,95%CI-64.64—-24.98,P<0.00001);the incidence of postoperative complications was decreased(OR=0.46,95%CI 0.28—0.77,P=0.003);the postoperative liver function index albumin(ALB)was elevated(MD=1.89,95%CI0.74—3.04,P=0.001);the hospitalization time was shortened(MD=-2.47,95%CI-3.25—-1.68),P<0.00001);the recurrence rate of liver cancer was reduced after 6 months to 1 year follow-up(OR=0.44,95%CI 0.22—0.88,P=0.02).There were no statistical differences between the two groups in respects of the incidence of postoperative liver function index alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL)as well as the survival rate of liver cancer after 6 months to 1 year follow-up(all P>0.05).Conclusion The application of3 DVT in precise diagnosis and treatment of PLC is safe and effective,and it can effectively reduce the intraoperative blood loss and the incidence of postoperative complications,accelerate the recovery of postoperative liver function,shorten the operation time and hospitalization time,and reduce the recurrence rate of liver cancer in short-term follow-up.