Zeng Lei, Zhu Yuming, Guo Peng
Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Evid Based Complement Alternat Med. 2022 Sep 13;2022:4507673. doi: 10.1155/2022/4507673. eCollection 2022.
The application of medical image three-dimensional (3D) reconstruction technology can provide intuitive 3D image data support for accurate preoperative evaluation, surgical planning, and operation safety. However, there is still a lack of high-quality evidence to support whether 3D reconstruction technology is more advantageous in liver resection. Therefore, this study systematically evaluated the clinical effects of 3D reconstruction and two-dimensional (2D) image-assisted hepatectomy.
Databases were searched to collect published clinical studies on 3D reconstruction technology and 2D image-assisted liver resection. Data were extracted from the database construction to March 2022 and the risk of bias in the included studies was evaluated. Meta-analysis was performed using RevMan5.3 software.
A total of 13 clinical studies were included, including 1616 patients, 795 in the 2D group and 819 in the 3D group. The meta-analysis showed that the incidence of postoperative complications was lower in the 3D group than in the 2D group (OR = 0.64, 95% CI = 0.49-0.83, =0.001) and also reduced operation time (SMD = -0.51, 95% CI = -0.74∼-0.27, < 0.0001), decreased intraoperative blood loss (SMD = -63.85, 95% CI = -98.66-29.04, =0.0003), decreased incidence of postoperative liver failure (OR = 2.42, 95% CI = 0.99-5.95, =0.05), decreased postoperative recurrence rate (OR = 0.29, 95% CI = 0.16-0.53, < 0.0001), and increased postoperative survival rate (OR = 2.19, 95% CI = 1.49-3.23, < 0.0001).
Current data suggest that 3D reconstruction-assisted hepatectomy can reduce intraoperative blood loss, postoperative complications, and recurrence, and improve postoperative survival. Therefore, the 3D reconstruction technique is worthy of application and promotion in assisted liver resection.
医学图像三维（3D）重建技术的应用可为准确的术前评估、手术规划及手术安全性提供直观的3D图像数据支持。然而，目前仍缺乏高质量证据支持3D重建技术在肝切除术中是否更具优势。因此，本研究系统评价了3D重建与二维（2D）图像辅助肝切除术的临床效果。
检索数据库以收集已发表的关于3D重建技术及2D图像辅助肝切除术的临床研究。从数据库建立至2022年3月提取数据，并评估纳入研究的偏倚风险。使用RevMan5.3软件进行荟萃分析。
共纳入13项临床研究，包括1616例患者，2D组795例，3D组819例。荟萃分析显示，3D组术后并发症发生率低于2D组（OR = 0.64，95%CI = 0.49 - 0.83，P = 0.001），手术时间也缩短（SMD = -0.51，95%CI = -0.74∼-0.27，P < 0.0001），术中出血量减少（SMD = -63.85，95%CI = -98.66 - 29.04，P = 0.0003），术后肝衰竭发生率降低（OR = 2.42，95%CI = 0.99 - 5.95，P = 0.05），术后复发率降低（OR = 0.29，95%CI = 0.16 - 0.53，P < 0.0001），术后生存率提高（OR = 2.19，95%CI = 1.49 - 3.23，P < 0.0001）。
目前数据表明，3D重建辅助肝切除术可减少术中出血量、术后并发症及复发，并提高术后生存率。因此，3D重建技术在辅助肝切除术中值得应用和推广。
