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三维可视化技术辅助肝细胞癌消融治疗有效性及安全性的Meta分析
DOI: 10.12449/JCH240718
利益冲突声明：本文不存在任何利益冲突。
作者贡献声明：李开富、唐永成负责数据收集，撰写论文；唐浩、张玺参与数据分析；高本见负责修改论文；罗德、苏松负责拟定写作思路；李波、杨小李负责课题设计，指导撰写文章并最后定稿。
Efficacy and safety of three-dimensional visualization technology in assisting ablation therapy for hepatocellular carcinoma： A Meta-analysis
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摘要:
目的 系统性评价三维可视化技术辅助肝细胞癌消融治疗的有效性和安全性。 方法 本研究根据PRISMA指南完成，PROSPERO注册号：CRD42023488398。计算机检索PubMed、Embase、Web of Science、Cochrane Library、中国知网数据库、万方数据库、维普数据库和中国生物医学文献数据库中公开发表的有关三维可视化技术辅助肝细胞癌消融治疗的所有中、英文文献，检索时间为自建库至2023年3月。对纳入的研究进行质量评价和数据提取后，采用RevMan 5.4软件进行Meta分析。 结果 最终纳入11篇文献，共972例患者，其中447例采用三维可视化技术辅助消融（3D组），525例采用常规二维影像技术辅助消融（2D组）。Meta分析结果显示，3D组首次治疗成功率（OR=5.43，95%CI：2.64～11.18，P<0.001）、技术有效率（OR=6.15，95%CI：3.23～11.70，P<0.001）、完全消融率（OR=2.50，95%CI：1.08～5.78，P=0.03）均显著高于2D组；在安全性方面，严重并发症发生率（OR=0.45，95%CI：0.24～0.87，P=0.02）、局部复发率（OR=0.35，95%CI：0.17～0.72，P=0.004）和局部肿瘤进展率（OR=0.29，95%CI：0.16～0.50，P<0.001）均明显低于2D组；两组的轻度并发症发生率比较，差异无统计学意义（P>0.05）。 结论 三维可视化技术辅助肝细胞癌消融治疗安全可行，可以提高消融率，并降低严重并发症发生率、局部复发率及局部肿瘤进展率，在临床中有重要应用价值。 Abstract:Objective To systematically evaluate the efficacy and safety of three-dimensional visualization technology in assisting ablation therapy for hepatocellular carcinoma. Methods This study was conducted according to PRISMA guidelines， with a PROSPERO registration number of CRD42023488398. PubMed， Embase， Web of Science， the Cochrane Library， CNKI， Wanfang Data， VIP， and CBM were searched for Chinese and English articles on three-dimensional visualization technology in assisting ablation therapy for hepatocellular carcinoma published up to March 2023. After quality assessment and data extraction of the studies included， RevMan 5.4 software was used to perform the meta-analysis. Results A total of 11 studies were included， with 972 patients in total， among whom 447 underwent ablation assisted by three-dimensional visualization technology （3D group） and 525 underwent ablation assisted by traditional two-dimensional imaging technology （2D group）. The meta-analysis showed that compared with the 2D group， the 3D group had significantly higher success rate of first-time ablation treatment （odds ratio ［OR］=5.43， 95% confidence interval ［CI］： 2.64 — 11.18， P<0.001）， technical efficiency （OR=6.15， 95%CI： 3.23 — 11.70， P<0.001）， and complete ablation rate （OR=2.50， 95%CI： 1.08 — 5.78， P=0.03）， as well as significantly lower incidence rate of major complications （OR=0.45， 95%CI： 0.24 — 0.87， P=0.02）， local recurrence rate （OR=0.35， 95%CI： 0.17 — 0.72， P=0.004）， and local tumor progression rate （OR=0.29， 95%CI： 0.16 — 0.50， P<0.001）， while there was no significant difference in the incidence rate of mild complications between the two groups （P>0.05）. Conclusion Three-dimensional visualization technology is safe and feasible in assisting ablation therapy for hepatocellular carcinoma and can improve ablation rate and reduce the incidence rate of serious complications， local recurrence rate， and local tumor progression rate， thereby showing an important application value in clinical practice. -
图 2 3D组与2D组首次治疗成功率的森林图
Figure 2. Forest plot of first treatment success rate in 3D group and 2D group
图 3 3D组与2D组技术有效率的森林图
Figure 3. Forest plot of technical efficiency in 3D group and 2D group
图 4 3D组与2D组完全消融率的森林图
Figure 4. Forest plot of complete ablation rate in 3D group and 2D group
图 5 3D组与2D组严重并发症发生率的森林图
Figure 5. Forest plot of major complication rates in 3D group and 2D group
图 6 3D组与2D组轻度并发症发生率的森林图
Figure 6. Forest plot of minor complication rates in 3D group and 2D group
图 7 3D组与2D组局部复发率的森林图
Figure 7. Forest plot of local recurrence rate in 3D group and 2D group
图 8 3D组与2D组局部肿瘤进展率的森林图
Figure 8. Forest plot of local tumor progression rate in 3D group and 2D group
表 1 纳入文献的基本特征
Table 1. Basic characteristics of the included studies
纳入文献 年份 国家 研究 类型 消融 方式 引导方式 样本量（例） 肿瘤大小（cm） 单发/多发 Child-Pugh分级 观察指标1） 3D组 2D组 3D组 2D组 3D组 2D组 蓝思荣等［16］ 2022 中国 RCT 微波消融 CEUS联合 3D超声 CEUS 51 51 1.90±0.60 A/B ②⑥⑦ 张艳云［17］ 2018 中国 RCT 微波消融 超声联合 3D技术 超声 40 40 大肝癌 ③ 廖华为［18］ 2017 中国 RCT 微波消融 3D技术 超声 34 34 大肝癌 多发 A/B ③④⑤ 赫嵘等［19］ 2022 中国 RCT 射频消融 超声 超声 34 37 1.40～2.50 1.50～2.40 多发 A/B ②④⑤ 韩玥等［20］ 2021 中国 RCT 微波消融 超声 22 29 2.50±0.80 2.70±1.10 多发 A/B ①②④⑥ 张雯雯等［21］ 2016 中国 非RCT 射频消融 腹腔镜 腹腔镜 32 64 <5.00 A/B ③④⑤ 唐云强等［13］ 2015 中国 非RCT 射频消融 超声 超声 49 60 3.00～5.00 单发 A/B ②④⑥ 王晓东等［22］ 2014 中国 RCT 射频消融 3D-CEUS联合2D-CEUS 2D-CEUS 64 64 3.46±0.88 3.45±1.05 单发 ② Zhang等［10］ 2019 中国 非RCT 微波消融 超声联合 3D技术 超声 19 24 4.14±0.95 4.07±0.91 单发 A/B ①②④ ⑤⑦ Liu等［23］ 2013 中国 非RCT 微波消融 超声 超声 36 58 3.11±1.30 3.05±1.04 多发 A/B/C ①③⑦ An等［24］ 2020 中国 非RCT 微波消融 CEUS CEUS 66 64 5.00±1.50 5.00±1.60 多发 A/B ①②④⑦ 注：1）观察指标包括①首次治疗成功率；②技术有效率；③完全消融率；④严重并发症发生率；⑤轻度并发症发生率；⑥局部复发率；⑦局部肿瘤进展率。CEUS，超声造影；3D-CEUS，三维超声造影；2D-CEUS，二维超声造影；大肝癌，文献未具体描述大小。 
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