| Objective:To evaluate clinical value of three-dimensional(3D)reconstruction compared with traditional computed tomography(CT)guided precise hepatectomy in the treatment for the patients with primary hepatic carcinoma and to investigate the effectiveness of 3D reconstruction in the postoperative survival rate and recurrence rate of the patients with primary hepatic carcinoma by means of Meta-analysis.Method:The literature on the randomized controlled trials in clinical application of preoperative3D reconstruction and conventional CT in surgical treatment of the patients with primary hepatic carcinoma published in English and Chinese before June 2018 were collected from databases including PubMed,Cochrane Library,Web of science,EMbase,CBM,CNKI,and WanFang Data with other retrieval methods at the same time.Keywords of Chinese and English were primary hepatic carcinoma,primary liver cancer,liver neoplasms,hepatocellular carcinoma,hepatectomy,and imaging,three-dimensional.Subject word and free word were adjusted according to different databases In the process of literature retrieval.Meta analysis was carried out using RevMan 5.3 software provided by the Cochrane Collaboration after selecting papers,extracting data and quality evaluation of the literature.The heterogeneity of all studies was assessed using theΙ~2 test.Data consolidation and analysis were made by the fixed effect model when the value ofΙ~2is less than 50%,Data consolidation and analysis were made by the randomized effect model when the value ofΙ~2 is more than 50%.Results:973 potentially relevant studies identified through initial searches of electronic databases by pre-designed retrieval scheme.9 trials(802 patients,3 randomized controlled trials and6 case control studies)evaluating different effectiveness between the groups of preoperative 3D reconstruction and conventional CT were included after repeated literature,case reports and reviews and studies with incomplete data were excluded.The amount of intraoperative blood loss in the 3D 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).The result of sensitivity analysis show that there were no significant difference beteen the groups of 3D reconstruction and conventional CT by one-by-one culling method and confirm stable results of this meta-analysis.No significant publication bias was detected by means of the funnel plot of the postoperative complication rate.Conclusion:3D reconstruction could more accurately predict the liver resection volume and surgical margin,provide precise anatomical position and simulate surgical approach,clearly display the vascular system of the liver,reduce intraperative bleeding and the postoperative recurrence rate.The use of 3D reconstruction could significantly improve the short-term survival rate and recovery of postoperative liver function compared with conventional CT in preoperative application of hepatectomy.The rational application of preoperative 3D reconstruction plays an important role in preoperative evaluation and surgical planning,and improves the efficacy and safety of hepatectomy. |
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