三维重建技术在肝癌切除术中应用价值的Meta分析
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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 efficacy and safety of hepatectomy.
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 efficacy and safety of hepatectomy.
引文
[1] Torre L A, Bray F, Siegel R L, et al. Global cancer statistics, 2012[J]. Ca Cancer J Clin, 2015, 65(2):87-108.
[2]苏昭杰,李文岗,黄军利,等.三维可视化技术在巨大肝癌术前精准评估中的应用[J].中华普通外科学文献:电子版,2016,10(3):188-191.
[3] Green S. Cochrane Handbook for Systematic Reviews of Interventions:Cochrane Book Series[M]. Wiley-Blackwell, 2008.
[4] Wells G. The Newcastle-Ottawa Scale(NOS)for assessing the quality of nonrandomised studies in meta-analyses[J]. Appl Eng Agric, 2014, 18(6):727-734.
[5]贾萌.三维重建技术联合腹腔镜精准肝切除术治疗原发性肝癌的临床疗效观察[J].肝胆外科杂志,2017,25(2):115-122.
[6]李博,李昆仑.不同技术在精准肝切除术中应用价值比较[J].肝胆外科杂志,2017,25(1):60-65.
[7]胡志刚,黄拼搏,周振宇,等.二维影像技术和三维可视化技术辅助ALPPS治疗肝癌效果的初步探讨[J].中华外科杂志,2016,54(9):686-691.
[8] Fang CH, Tao HS, Yang J, et al. Impact of Three-Dimensional Reconstruction Technique in the Operation Planning of Centrally Located Hepatocellular Carcinoma[J]. J Am Coll Surg, 2015, 220(1):28-37.
[9]邵贤,贾乃昕,陈佳慧.应用三维重建及虚拟肝切除系统的腹腔镜下精准切除右肝肿瘤[J].中华普通外科杂志,2016,31(7):538-540.
[10] Nakayama K, Oshiro Y, Miyamoto R, et al. The Effect of ThreeDimensional Preoperative Simulation on Liver Surgery[J]. World J Surg, 2017, 41(7):1840-1847.
[11]王松平,李建生,马金良,等.三维重建技术在精准肝切除中的临床应用[J].世界华人消化杂志,2014,(15):2169-2174.
[12]黄海.精准肝切除治疗原发性肝癌的临床疗效[J].江苏医药,2014,40(1):42-44.
[13]荚卫东,陈浩,葛勇胜,等.三维可视化技术在巨块型肝细胞癌精准肝切除中的应用价值[J].中华肝胆外科手术学电子杂志,2018,7(1):35-39.
[14] Mcglynn KA, Petrick JL, London WT, et al. Global Epidemiology:An Emphasis on Demographic and Regional Variability[J]. Clin Liver Dis, 2015, 19(2):223-238.
[15]董家鸿,杨世忠.精准肝切除的技术特征与临床应用[J].中国实用外科杂志,2010,(8):638-640.
[16] Wang XD, Wang HG, Shi J, et al. Traditional surgical planning of liver surgery is modified by 3D interactive quantitative surgical planning approach:a single-center experience with 305 patients[J]. Hepatobil Pancreat Dis Int, 2017, 16(3):271-278.
[17] Nakayama K, Oshiro Y, Miyamoto R, et al. The Effect of ThreeDimensional Preoperative Simulation on Liver Surgery[J]. World J Surg, 2017, 41(7):1840.
[18]陈琳,罗鸿萍,董水林,等.三维重建技术在评估大肝癌手术安全性中的作用[J].中华外科杂志,2016,54(9):669-674.
[19] Lamad W, Glombitza G, Fischer L, et al. The impact of 3-dimensional reconstructions on operation planning in liver surgery[J].Arch Surg, 2000, 135(11):1256-1261.
[20] Wigmore SJ, Redhead DN, Yan XJ, et al. Virtual hepatic resection using three-dimensional reconstruction of helical computed tomography angioportograms[J]. Ann Surg, 2001, 233(2):221-226.
[21] Waghray A, Murali AR, Menon K2N. Hepatocellular carcinoma:From diagnosis to treatment[J]. World J Hepatol, 2015, 7(8):74-85.
[22] Ge PL, Du SD, Mao YL. Advances in preoperative assessment of liver function[J]. Hepatobil Pancreat Dis Int, 2014, 13(4):361-370.
[23] Radtke A, Sotiropoulos GC, Molmenti EP, et al. Computer-assisted surgery planning for complex liver resections:when is it helpful? A single-center experience over an 8-year period[J]. Ann Surg,2010, 252(5):876-883.
[24] Cai W, Fan Y, Hu H, et al. Postoperative liver volume was accurately predicted by a medical image three dimensional visualization system in hepatectomy for liver cancer[J]. Surg Oncol, 2017,26(2):188-194.
[25]张小晶,刘静,刘坤,等.微血管侵犯对肝癌肝切除术后预后的影响[J].中华消化外科杂志,2018,17(5):483.
[26] Poon RT, Fan ST, Ng IO, et al. Different risk factors and prognosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma[J]. Cancer, 2015, 89(3):500-507.
[27] Poon RT, Fan ST, Ng IO, et al. Risk factors and management for early and late intrahepatic recurrence of solitary hepatocellular carcinoma after curative resection[J]. HPB, 2015, 17(5):422-427.
[28] Wei XB, Xu J, Li N, et al. The role of three-dimensional imaging in optimizing diagnosis, classification and surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus[J]. HPB,2016, 18(3):287-295.
[2]苏昭杰,李文岗,黄军利,等.三维可视化技术在巨大肝癌术前精准评估中的应用[J].中华普通外科学文献:电子版,2016,10(3):188-191.
[3] Green S. Cochrane Handbook for Systematic Reviews of Interventions:Cochrane Book Series[M]. Wiley-Blackwell, 2008.
[4] Wells G. The Newcastle-Ottawa Scale(NOS)for assessing the quality of nonrandomised studies in meta-analyses[J]. Appl Eng Agric, 2014, 18(6):727-734.
[5]贾萌.三维重建技术联合腹腔镜精准肝切除术治疗原发性肝癌的临床疗效观察[J].肝胆外科杂志,2017,25(2):115-122.
[6]李博,李昆仑.不同技术在精准肝切除术中应用价值比较[J].肝胆外科杂志,2017,25(1):60-65.
[7]胡志刚,黄拼搏,周振宇,等.二维影像技术和三维可视化技术辅助ALPPS治疗肝癌效果的初步探讨[J].中华外科杂志,2016,54(9):686-691.
[8] Fang CH, Tao HS, Yang J, et al. Impact of Three-Dimensional Reconstruction Technique in the Operation Planning of Centrally Located Hepatocellular Carcinoma[J]. J Am Coll Surg, 2015, 220(1):28-37.
[9]邵贤,贾乃昕,陈佳慧.应用三维重建及虚拟肝切除系统的腹腔镜下精准切除右肝肿瘤[J].中华普通外科杂志,2016,31(7):538-540.
[10] Nakayama K, Oshiro Y, Miyamoto R, et al. The Effect of ThreeDimensional Preoperative Simulation on Liver Surgery[J]. World J Surg, 2017, 41(7):1840-1847.
[11]王松平,李建生,马金良,等.三维重建技术在精准肝切除中的临床应用[J].世界华人消化杂志,2014,(15):2169-2174.
[12]黄海.精准肝切除治疗原发性肝癌的临床疗效[J].江苏医药,2014,40(1):42-44.
[13]荚卫东,陈浩,葛勇胜,等.三维可视化技术在巨块型肝细胞癌精准肝切除中的应用价值[J].中华肝胆外科手术学电子杂志,2018,7(1):35-39.
[14] Mcglynn KA, Petrick JL, London WT, et al. Global Epidemiology:An Emphasis on Demographic and Regional Variability[J]. Clin Liver Dis, 2015, 19(2):223-238.
[15]董家鸿,杨世忠.精准肝切除的技术特征与临床应用[J].中国实用外科杂志,2010,(8):638-640.
[16] Wang XD, Wang HG, Shi J, et al. Traditional surgical planning of liver surgery is modified by 3D interactive quantitative surgical planning approach:a single-center experience with 305 patients[J]. Hepatobil Pancreat Dis Int, 2017, 16(3):271-278.
[17] Nakayama K, Oshiro Y, Miyamoto R, et al. The Effect of ThreeDimensional Preoperative Simulation on Liver Surgery[J]. World J Surg, 2017, 41(7):1840.
[18]陈琳,罗鸿萍,董水林,等.三维重建技术在评估大肝癌手术安全性中的作用[J].中华外科杂志,2016,54(9):669-674.
[19] Lamad W, Glombitza G, Fischer L, et al. The impact of 3-dimensional reconstructions on operation planning in liver surgery[J].Arch Surg, 2000, 135(11):1256-1261.
[20] Wigmore SJ, Redhead DN, Yan XJ, et al. Virtual hepatic resection using three-dimensional reconstruction of helical computed tomography angioportograms[J]. Ann Surg, 2001, 233(2):221-226.
[21] Waghray A, Murali AR, Menon K2N. Hepatocellular carcinoma:From diagnosis to treatment[J]. World J Hepatol, 2015, 7(8):74-85.
[22] Ge PL, Du SD, Mao YL. Advances in preoperative assessment of liver function[J]. Hepatobil Pancreat Dis Int, 2014, 13(4):361-370.
[23] Radtke A, Sotiropoulos GC, Molmenti EP, et al. Computer-assisted surgery planning for complex liver resections:when is it helpful? A single-center experience over an 8-year period[J]. Ann Surg,2010, 252(5):876-883.
[24] Cai W, Fan Y, Hu H, et al. Postoperative liver volume was accurately predicted by a medical image three dimensional visualization system in hepatectomy for liver cancer[J]. Surg Oncol, 2017,26(2):188-194.
[25]张小晶,刘静,刘坤,等.微血管侵犯对肝癌肝切除术后预后的影响[J].中华消化外科杂志,2018,17(5):483.
[26] Poon RT, Fan ST, Ng IO, et al. Different risk factors and prognosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma[J]. Cancer, 2015, 89(3):500-507.
[27] Poon RT, Fan ST, Ng IO, et al. Risk factors and management for early and late intrahepatic recurrence of solitary hepatocellular carcinoma after curative resection[J]. HPB, 2015, 17(5):422-427.
[28] Wei XB, Xu J, Li N, et al. The role of three-dimensional imaging in optimizing diagnosis, classification and surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus[J]. HPB,2016, 18(3):287-295.
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