三维重建技术在肝癌切除术中应用价值的Meta分析  

Clinical application value of three-dimensional reconstruction technique in hepatectomy:A Meta-analysis

作　　者：赵鹏翔 邢雪[1] ZHAO Peng-xiang;XING Xue(Department of Hepatobiliary and Pancreatic Surgery, Affiliated Qingdao Municipal Hospital of Qingdao University(Qingdao 266071,China))

机构地区：[1]青岛大学附属青岛市市立医院肝胆外科

出　　处：《中国现代普通外科进展》2019年第4期284-290,295,共8页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:系统评价术前三维重建技术在肝癌手术中的应用。方法:运用计算机检索Pub Med、Cochrane Library、Web of science、EMbase、CBM、CNKI和WanFang Data,同时辅以其他检索方式,收集2018年6月前所有公开发表术前三维重建与传统CT在肝癌手术应用的随机对照实验和病例对照研究。按照纳入标准选择文献、提取资料和进行纳入文献的质量评价后,运用Cochrane协作网提供的Rev Man 5.3软件进行Meta分析。结果:共有9篇文章纳入研究,包含800例患者。三维重建组与传统CT组相比,术中出血量[SMD=-1.17,95%CI(-1.87,-0.48),P=0.0010]、术后住院天数[MD=-2.10,95%CI(-3.29,-0.91),P=0.0005]、术后并发症[OR=0.50,95%CI(0.34,0.75),P=0.0009]、术后1周谷丙转氨酶水平[MD=-9.12,95%CI(-14.80,-3.44),P<0.002]、术后1周总胆红素水平[MD=-2.58,95%CI(-3.37,-1.80),P<0.00001]、术后1周谷草转氨酶水平[MD=-6.66,95%CI(-8.09,-5.23),P<0.00001]、术后生存率[OR=3.94,95%CI(1.54,10.12),P=0.004]、术后复发率[OR=0.25,95%CI(0.10,0.59),P=0.002]均有统计学意义。在手术操作时间方面[SMD=0.38,95%CI(-0.52,1.28),P=0.41],两组数据结果无统计学差异。结论:术前三维重建技术可以清楚地显示出肝脏的解剖结构和病变的特征,比传统的二维成像更准确估计肝体积和切除边缘,在术前评估和手术规划中发挥重要作用,能够提高肝切除术的疗效和安全性。Objective: To evaluate clinical value of preoperative three-dimensional reconstruction technique in liver cancer surgery. Methods: The literature on the randomized controlled trials in clinical application of preoperative 3 D reconstruction and conventional CT in surgical treatment of the patients with primary hepatic carcinoma published before June 2018 were collected from databases including Pub Med, Cochrane Library, Web of science, EMbase, CBM, CNKI, and WanFang Data with other retrieval methods at the same time.Meta analysis was carried out using Rev Man 5.3 software provided by the Cochrane Collaboration after selecting papers, extracting data and quality evaluation of the literature. Results: 9 trials(800 patients) evaluating different effectiveness between preoperative 3 D reconstruction and conventional CT were included. Compared with the conventional CT group, the amount of intraoperative blood loss in the 3 D reconstruction group(SMD=-1.17, 95% CI=[-1.87,-0.48], P=0.0010), postoperative hospital stay(MD=-2.10, 95% CI=[-3.29,-0.91], P=0.0005),postoperative complications(OR=0.50,95%CI=[0.34,0.75],P=0.0009), a week’s alanine aminotransferase level(MD)=-9.12, 95% CI=[-14.80,-3.44], P<0.002), total bilirubin levels one week after surgery(MD=-2.58, 95% CI=[-3.37,-1.80], P<0.00001), the level of aspartate aminotransferase(MD=-6.66,95%CI=[-8.09,-5.23], P<0.00001) and the short-term survival rate after surgery(OR=3.94, 95% CI=[1.54, 10.12], P=0.004), the recent recurrence rate(OR=0.25, 95% CI=[0.10, 0.59], P=0.002) were statistically significant. However, no statistical difference was detected in terms of surgical operation time(SMD=0.38, 95% CI=[-0.52, 1.28], P=0.41). Conclusion: Preoperative 3 D reconstruction technology clearly shows the anatomical structure of the liver and the characteristics of the lesion. It is more accurate than traditional 2 D imaging to estimate liver volume and resection margin, and plays an important role in preoperative evaluation and surgical planning which could improve the eff

关 键 词：肝癌 肝切除术 三维重建 META分析 

分 类 号：R735.7[医药卫生—肿瘤]