三维可视化技术与二维影像比较辅助肝切除术临床效果的Meta分析
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摘要
目的系统评价三维可视化技术与二维影像辅助肝切除术的临床效果。方法计算机检索EMbase、Pub Med、The Cochrane Library、CBM、CNKI、Wan Fang Data和VIP数据库,搜集国内外公开发表的有关三维可视化技术与二维影像辅助肝切除术比较的临床研究,检索时限均从建库至2017年9月。由2名研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果共纳入11个临床研究,其中7个队列研究、3个自身对照试验和1个非同期对照试验,包括953例患者。Meta分析结果显示,与传统二维影像技术相比,三维可视化技术可提高根治性手术切除率(R0切除率)[OR=2.91,95%CI(1.31,6.43),P=0.009]、降低术后并发症发生率[OR=0.55,95%CI(0.38,0.80),P=0.002]、减少术中输血量[MD=–96.05,95%CI(–126.78,–65.31),P<0.000 01]、减少术前预测切除体积与术中实际切除体积之间的偏差[MD=–94.38,95%CI(–185.46,–3.30),P=0.04]、缩短手术时间[MD=–33.58,95%CI(–60.09,–7.08),P=0.01]和减少术中出血量[MD=–79.70,95%CI(–139.86,–19.53),P=0.009]。但两组住院时间[MD=–0.75,95%CI(–2.45,0.95),P=0.39]的差异无统计学意义。结论当前证据显示,应用三维可视化技术辅助肝切除术,可更好预测肝脏肿瘤切除体积、提高肝脏肿瘤R0切除率、缩短手术时间、减少术中输血量及出血量、减少术后并发症发生。受纳入研究数量和质量的限制,上述结论尚待开展更多高质量研究予以验证。
Objectives To systematically review the clinical efficacy of three-dimensional(3 D) visualization vs.two-dimensional(2 D) imaging technique in hepatectomy. Methods Pub Med, EMbase, The Cochrane Library, CBM,CNKI, Wan Fang Data and VIP databases were electronically searched to collect clinical trials which compared 3 D visualization with conventional 2 D imaging technique for hepatectomy from inception to September 2017. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies, and then, meta-analysis was performed by using Rev Man 5.3 software. Results A total of 11 studies involving 953 patients were included. The results of meta-analysis showed that: compared to 2 D imaging technique, 3 D visualization technique could improve R0 resection rate(OR=2.91, 95%CI 1.31 to 6.43, P=0.009), had lower incidence of postoperative complication(OR=0.55,95%CI 0.38 to 0.80, P=0.002), less amount of blood transfusion in operation(MD=–96.05, 95%CI –126.78 to –65.31,P<0.000 01), lower discrepancy range between the volume of the predicted liver resection and actual resection volume(MD=–94.38, 95%CI –185.46 to –3.30, P=0.04), shorter operation time(MD=–33.58, 95%CI –60.09 to –7.08, P=0.01),and lower intraoperative blood loss(MD=–79.70, 95%CI –139.86 to –19.53, P=0.009), the differences were statistically significant. There were no statistical differences between two groups in postoperative hospital stay time(MD=–0.75,95%CI –2.45 to 0.95, P=0.39). Conclusions The current evidence shows that application of 3 D visualization technique in hepatectomy can predict the liver resection volume more accurately, improve the R0 resection rate, shorten operation time, decrease intraoperative blood transfusion volume and the amount of bleeding, and reduce the incidence of postoperative complications. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusion.
Objectives To systematically review the clinical efficacy of three-dimensional(3 D) visualization vs.two-dimensional(2 D) imaging technique in hepatectomy. Methods Pub Med, EMbase, The Cochrane Library, CBM,CNKI, Wan Fang Data and VIP databases were electronically searched to collect clinical trials which compared 3 D visualization with conventional 2 D imaging technique for hepatectomy from inception to September 2017. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies, and then, meta-analysis was performed by using Rev Man 5.3 software. Results A total of 11 studies involving 953 patients were included. The results of meta-analysis showed that: compared to 2 D imaging technique, 3 D visualization technique could improve R0 resection rate(OR=2.91, 95%CI 1.31 to 6.43, P=0.009), had lower incidence of postoperative complication(OR=0.55,95%CI 0.38 to 0.80, P=0.002), less amount of blood transfusion in operation(MD=–96.05, 95%CI –126.78 to –65.31,P<0.000 01), lower discrepancy range between the volume of the predicted liver resection and actual resection volume(MD=–94.38, 95%CI –185.46 to –3.30, P=0.04), shorter operation time(MD=–33.58, 95%CI –60.09 to –7.08, P=0.01),and lower intraoperative blood loss(MD=–79.70, 95%CI –139.86 to –19.53, P=0.009), the differences were statistically significant. There were no statistical differences between two groups in postoperative hospital stay time(MD=–0.75,95%CI –2.45 to 0.95, P=0.39). Conclusions The current evidence shows that application of 3 D visualization technique in hepatectomy can predict the liver resection volume more accurately, improve the R0 resection rate, shorten operation time, decrease intraoperative blood transfusion volume and the amount of bleeding, and reduce the incidence of postoperative complications. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusion.
引文
1郑宗英,杨元华.超声引导细针穿刺抽吸组织学检查对肝脏恶性肿瘤的诊断研究.中华物理医学与康复杂志,1991,13(4):207-210.
2 周俭,黄成,樊嘉.肝移植相关技术在复杂肝脏肿瘤切除术中的应用.中华肝脏外科手术学电子杂志,2012,1(3):147-150.
3方驰华,陶海粟.影像学新技术在肝胆胰外科精准诊断与治疗中的应用.中华消化外科杂志,2016,15(1):22-26.
4 刘允怡,张绍祥,姜洪池,等.复杂性肝脏肿瘤三维可视化精准诊治专家共识.中国实用外科杂志,2017,37(1):53-59.
5刘春.22例外生性肝癌的诊治分析.长沙:中南大学,2009.
6肖林峰.三维可视化重建技术在腹部外科术前评估的临床应用研究.厦门:厦门大学,2014.
7陶海粟.三维可视化技术在中央型肝癌诊治中的应用.广州:南方医科大学,2016.
8舒晓亮,康凯,钟静霞,等.高支链氨基酸营养支持对肝脏手术患者肝功能保护作用的Meta分析.中华肝脏病杂志,2014,22(1):43-47.
9 杨凝清.信息时代医学信息教育模式初探.中华医学图书情报杂志,2002,11(6):1-3.
10周为文,葛龙,徐俊峰,等.《中国循证医学杂志》发表的干预类系统评价/Meta分析报告质量评价.中国循证医学杂志,2013,13(4):482-488.
11 Zeng X,Zhang Y,Kwong JS,et al.The methodological quality assessment tools for preclinical and clinical studies,systematic review and meta-analysis,and clinical practice guideline:a systematic review.J Evid Based Med,2015,8(1):2-10.
12Higgins JP,Green S.Cochrane Handbook for Systematic Reviews of Interventions.Available at:http://:handbook.cochrane.org.
13 李慧,毛绍菊,孙玮璇,等.镉与老年性痴呆相关性的Meta分析.中国循证医学杂志,2015,15(9):1030-1034.
14张豆豆,陈海锋,黄思庆,等.后颅窝减压及硬膜成形术与单纯后颅窝减压术比较治疗Ⅰ型Chiari畸形效果的Meta分析.中国循证医学杂志,2012,12(9):1090-1097.
15 Bégin A,Martel G,Lapointe R,et al.Accuracy of preoperative automatic measurement of the liver volume by CT-scan combined to a 3D virtual surgical planning software(3DVSP).Surg Endosc,2014,28(12):3408-3412.
16Yamanaka J,Saito S,Fujimoto J.Impact of preoperative planning using virtual segmental volume try on liver resection for hepatocellular carcinoma.World J Surg,2007,31(6):1251-1257.
17 Pianka F,Baumhauer M,Stein D,et al.Liver tissue sparing resection using a novel planning tool.Langenbecks Arch Surg,2011,396(2):201-208.
18Su L,Dong Q,Zhang H,et al.Clinical application of a threedimensional imaging technique in infants and young children with complex liver tumors.Pediatr Surg Int,2016,32(4):387-395.
19 Fang CH,Tao HS,Yang J,et al.Impact of three-dimensional reconstruction technique in the operation planning of centrallylocated hepatocellular carcinoma.J Am Coll Surg,2015,220(1):28-37.
20Okuda Y,Taura K,Seo S,et al.Usefulness of operative planning based on 3-dimensional CT cholangiography for biliary malignancies.Surgery,2015,158(5):1261-1271.
21 Fang CH,Liu J,Fan YF,et al.Outcomes of hepatectomy for hepatolithiasis based on 3-dimensional reconstruction technique.J Am Coll Surg,2013,217(2):280-288.
22Yi-Biao,Tuerganaili,Jiang,et al.Application of 3D reconstruction for surgical treatment of hepatic alveolar echinococcosis.World J Gastroenterol,2015,21(35):10200-10207.
23 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.中华外科杂志,2016,54(9):686-691.686-691.
24方驰华,陈青山,方程,等.三维可视化技术辅助的肝切除术治疗原发性肝癌的疗效分析.中华外科杂志,2015,53(8):574-579.
25 余璠,鲁正.三维可视化技术在肝门部胆管癌术前评估中的应用.中国肿瘤临床,2017,44(8):390-394.
26胡志刚,黄拼搏,周振宇,等.医学三维可视化技术在肝癌切除术中的应用现状及发展趋势.中国实用外科杂志,2016,36(6):699-701.
27 陈华伟.基于MRA数据的颈动脉三维可视化研究与实现.武汉:武汉理工大学,2015.
28刘凯,于红,刘士远,等.图像处理技术在医学影像学教学中的意义.临床和实验医学杂志,2010,9(18):1437-1437.
29董家鸿,杨世忠,段伟东,等.精准肝脏外科技术在复杂肝脏占位性病变切除中的应用.中华外科杂志,2009,47(21):1610-1615.
30范应方,项楠,蔡伟,等.三维可视化技术在精准肝切除术前规划中的应用.中华肝脏外科手术学电子杂志,2014,3(5):271-275.
31 李建平,杨军.精准肝切除研究进展.中华肝胆外科杂志,2011,17(5):434-436.
2 周俭,黄成,樊嘉.肝移植相关技术在复杂肝脏肿瘤切除术中的应用.中华肝脏外科手术学电子杂志,2012,1(3):147-150.
3方驰华,陶海粟.影像学新技术在肝胆胰外科精准诊断与治疗中的应用.中华消化外科杂志,2016,15(1):22-26.
4 刘允怡,张绍祥,姜洪池,等.复杂性肝脏肿瘤三维可视化精准诊治专家共识.中国实用外科杂志,2017,37(1):53-59.
5刘春.22例外生性肝癌的诊治分析.长沙:中南大学,2009.
6肖林峰.三维可视化重建技术在腹部外科术前评估的临床应用研究.厦门:厦门大学,2014.
7陶海粟.三维可视化技术在中央型肝癌诊治中的应用.广州:南方医科大学,2016.
8舒晓亮,康凯,钟静霞,等.高支链氨基酸营养支持对肝脏手术患者肝功能保护作用的Meta分析.中华肝脏病杂志,2014,22(1):43-47.
9 杨凝清.信息时代医学信息教育模式初探.中华医学图书情报杂志,2002,11(6):1-3.
10周为文,葛龙,徐俊峰,等.《中国循证医学杂志》发表的干预类系统评价/Meta分析报告质量评价.中国循证医学杂志,2013,13(4):482-488.
11 Zeng X,Zhang Y,Kwong JS,et al.The methodological quality assessment tools for preclinical and clinical studies,systematic review and meta-analysis,and clinical practice guideline:a systematic review.J Evid Based Med,2015,8(1):2-10.
12Higgins JP,Green S.Cochrane Handbook for Systematic Reviews of Interventions.Available at:http://:handbook.cochrane.org.
13 李慧,毛绍菊,孙玮璇,等.镉与老年性痴呆相关性的Meta分析.中国循证医学杂志,2015,15(9):1030-1034.
14张豆豆,陈海锋,黄思庆,等.后颅窝减压及硬膜成形术与单纯后颅窝减压术比较治疗Ⅰ型Chiari畸形效果的Meta分析.中国循证医学杂志,2012,12(9):1090-1097.
15 Bégin A,Martel G,Lapointe R,et al.Accuracy of preoperative automatic measurement of the liver volume by CT-scan combined to a 3D virtual surgical planning software(3DVSP).Surg Endosc,2014,28(12):3408-3412.
16Yamanaka J,Saito S,Fujimoto J.Impact of preoperative planning using virtual segmental volume try on liver resection for hepatocellular carcinoma.World J Surg,2007,31(6):1251-1257.
17 Pianka F,Baumhauer M,Stein D,et al.Liver tissue sparing resection using a novel planning tool.Langenbecks Arch Surg,2011,396(2):201-208.
18Su L,Dong Q,Zhang H,et al.Clinical application of a threedimensional imaging technique in infants and young children with complex liver tumors.Pediatr Surg Int,2016,32(4):387-395.
19 Fang CH,Tao HS,Yang J,et al.Impact of three-dimensional reconstruction technique in the operation planning of centrallylocated hepatocellular carcinoma.J Am Coll Surg,2015,220(1):28-37.
20Okuda Y,Taura K,Seo S,et al.Usefulness of operative planning based on 3-dimensional CT cholangiography for biliary malignancies.Surgery,2015,158(5):1261-1271.
21 Fang CH,Liu J,Fan YF,et al.Outcomes of hepatectomy for hepatolithiasis based on 3-dimensional reconstruction technique.J Am Coll Surg,2013,217(2):280-288.
22Yi-Biao,Tuerganaili,Jiang,et al.Application of 3D reconstruction for surgical treatment of hepatic alveolar echinococcosis.World J Gastroenterol,2015,21(35):10200-10207.
23 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.中华外科杂志,2016,54(9):686-691.686-691.
24方驰华,陈青山,方程,等.三维可视化技术辅助的肝切除术治疗原发性肝癌的疗效分析.中华外科杂志,2015,53(8):574-579.
25 余璠,鲁正.三维可视化技术在肝门部胆管癌术前评估中的应用.中国肿瘤临床,2017,44(8):390-394.
26胡志刚,黄拼搏,周振宇,等.医学三维可视化技术在肝癌切除术中的应用现状及发展趋势.中国实用外科杂志,2016,36(6):699-701.
27 陈华伟.基于MRA数据的颈动脉三维可视化研究与实现.武汉:武汉理工大学,2015.
28刘凯,于红,刘士远,等.图像处理技术在医学影像学教学中的意义.临床和实验医学杂志,2010,9(18):1437-1437.
29董家鸿,杨世忠,段伟东,等.精准肝脏外科技术在复杂肝脏占位性病变切除中的应用.中华外科杂志,2009,47(21):1610-1615.
30范应方,项楠,蔡伟,等.三维可视化技术在精准肝切除术前规划中的应用.中华肝脏外科手术学电子杂志,2014,3(5):271-275.
31 李建平,杨军.精准肝切除研究进展.中华肝胆外科杂志,2011,17(5):434-436.