三维血管重建联合三维导航在腹腔镜肝切除术中的临床疗效与安全性：系统评价与Meta分析
Clinical efficacy and safety of 3D vascular reconstruction combined with 3D navigation in laparoscopic hepatectomy: systematic review and meta-analysis.
作者信息
Jiang Jihua, Pei Lei, Jiang Renya
机构信息
Department of Hepatobiliary Surgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, China.
Department of Radiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, China.
出版信息
J Gastrointest Oncol. 2022 Jun;13(3):1215-1223. doi: 10.21037/jgo-22-198.
BACKGROUND
Meta-analysis was used to compare the difference between 3D reconstruction technology and 2D computed tomography (CT) before surgery for primary hepatic carcinoma (PHC) and to systematically evaluate the application value of 3D vascular reconstruction and 3D navigation technology in guiding precise liver resection for PHC. However, there are still many controversies in this aspect, and there are no clear conclusions on the effectiveness and safety of three-dimensional vascular reconstruction combined with three-dimensional navigation in laparoscopic hepatectomy. Therefore, it is necessary to systematically review the results of previous studies with meta method in this study to determine their clinical efficacy and complications and guide clinical treatment.
METHODS
We used the Cochrane Library, PubMed, Embase, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodicals Full-Text Database (VIP), and Wanfang database to conduct an online search for data from randomized controlled trials of preoperative 3D reconstruction versus conventional CT in hepatectomy published up to October 2021. Relevant literature was selected based on the inclusion criteria, data was extracted, and quality evaluation of the included literature was carried out. I test was used to evaluate heterogeneity among the studies, and Cochrane risk of bias 2.0 was used to evaluate the studies.
RESULTS
A total of 16 studies were included in this study. Meta-analysis showed that there were statistically significant differences between the 3D vascular reconstruction group and conventional surgery group in operation time [mean differences (MD) =-40.10, 95% confidence interval (CI): -74.94, -5.26, P=0.02, I=78%, Z=2.26] and intraoperative blood loss (MD =-50.40, 95% CI: -62.93, -37.86, P<0.00001, I=9%, Z=7.88), but no statistically significant difference was found in total days in hospital (MD =-0.39, 95% CI: -1.81, 1.03, P=0.59, I=76%, Z=0.54), and postoperative complications rate (OR =0.98, 95% CI: 0.64, 1.50, P=0.91, I=0%, Z=0.11).
DISCUSSION
Preoperative 3D reconstruction plays an important role in preoperative evaluation and surgical planning, which improves the operation time of PHC and reduces the intraoperative blood loss, but no effect to length of stay in hospital or complication rate comparing to conventional 2D techniques.
背景
采用Meta分析比较三维（3D）重建技术与二维计算机断层扫描（CT）在原发性肝癌（PHC）术前的差异，并系统评价3D血管重建及3D导航技术在指导PHC精准肝切除中的应用价值。然而，这方面仍存在诸多争议，三维血管重建联合三维导航在腹腔镜肝切除术中的有效性和安全性尚无明确结论。因此，本研究有必要采用Meta方法系统回顾既往研究结果，以确定其临床疗效及并发症情况，指导临床治疗。
方法
利用Cochrane图书馆、PubMed、Embase、中国生物医学文献数据库（CBM）、中国知网（CNKI）、中国科技期刊全文数据库（VIP）和万方数据库，在线检索截至2021年10月发表的关于肝切除术前3D重建与传统CT随机对照试验的数据。根据纳入标准选择相关文献，提取数据，并对纳入文献进行质量评价。采用I²检验评估研究间的异质性，使用Cochrane偏倚风险2.0评估研究。
结果
本研究共纳入16项研究。Meta分析显示，3D血管重建组与传统手术组在手术时间[平均差（MD）=-40.10，95%置信区间（CI）：-74.94，-5.26，P=0.02，I²=78%，Z=2.26]和术中出血量（MD=-50.40，95%CI：-62.93，-37.86，P<0.00001，I²=9%，Z=7.88）方面存在统计学显著差异，但在总住院天数（MD=-0.39，95%CI：-1.81，1.03，P=0.59，I²=76%，Z=0.54）和术后并发症发生率（OR=0.98，95%CI：0.64，1.50，P=0.91，I²=0%，Z=0.11）方面未发现统计学显著差异。
讨论
术前3D重建在术前评估和手术规划中发挥着重要作用，可缩短PHC的手术时间并减少术中出血量，但与传统二维技术相比对住院时间或并发症发生率无影响。
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