探讨三维重建在腹腔镜肝癌肝切除术的应用价值。

在PubMed、Cochrane Library、Embase、中国生物医学文献、CNKI、万方、维普数据库检索从建库至2019年2月期间发表的关于三维重建联合腹腔镜肝切除治疗肝肿瘤的随机对照研究（RCT）、队列研究或病例对照研究的中英文文献。中文检索词主要包括肝肿瘤、肝癌、肝切除、腹腔镜、三维重建；英文检索词主要包括hepatoma、hepatectomy、laparoscope、three-dimensional reconstruction。对纳入文献提取手术情况及术后肝功能等数据进行Meta分析。

最终纳入符合标准的文献8篇，共534例患者，其中采用三维重建的实验组245例，对照组289例。Meta分析结果显示，实验组与对照组手术时间（MD=-36.48，95%CI：-52.00～-20.96，Z=4.61，P<0.05）、术中出血量（MD=-109.36，95%CI：-142.03～-76.69，Z=6.56，P<0.05）、术后并发症（OR=0.42，95%CI：0.28～0.62，Z=4.38，P<0.05）、术后住院时间（MD=-3.31，95%CI：-4.16～-2.47，Z=7.66，P<0.05）、术后ALT（MD=-7.23，95%CI：-8.39～-6.07，Z=12.17，P<0.05）、AST（MD=-5.37，95%CI：-8.59～-2.14，Z=3.26，P<0.05）、TB（MD=-2.84，95%CI：-3.45～-2.23，Z=9.09，P<0.05）比较，差异均有统计学意义。亚组分析结果显示手术时间、术中出血量及术后住院时间的异质性主要来源于腹腔镜肝切除的难易程度。

三维重建技术应用于腹腔镜肝癌肝切除术能提高手术安全性和疗效，缩短手术时间，减少术中出血量，降低术后并发症发生风险。

To explore the application value of three-dimensional reconstruction in laparoscopic hepatectomy for liver cancer.

Literature in Chinese or English about randomized controlled study (RCT), cohort study or case-control study of three-dimensional reconstruction combined with laparoscopic hepatectomy for liver tumors was retrieved in PubMed, Cochrane Library, Embase, SinoMed, CNKI, Wanfang and Chongqing VIP databases from the inception of database to February 2019. The Chinese and English searching terms included hepatoma, liver cancer, hepatectomy, laparoscope and three-dimensional reconstruction. Clinical data including perioperative condition and postoperative liver function were extracted for Meta-analysis.

8 articles of 534 patients were eventually included. Among them, 245 cases were assigned into the experimental group in which three-dimensional reconstruction was used and 289 cases in the control group. Meta-analysis showed that the operation time (MD=-36.48, 95%CI:-52.00 to -20.96, Z=4.61, P<0.05), intraoperative blood loss (MD=-109.36, 95%CI:-142.03 to -76.69, Z=6.56, P<0.05), incidence of postoperative complications (OR=0.42, 95%CI: 0.28 to 0.62, Z=4.38, P<0.05), length of postoperative hospital stay (MD=-3.31, 95%CI:-4.16 to -2.47, Z=7.66, P<0.05), postoperative ALT level (MD=-7.23, 95%CI: -8.39 to -6.07, Z=12.17, P<0.05), postoperative AST level (MD=-5.37, 95%CI:-8.59 to -2.14, Z=3.26, P<0.05) and postoperative TB level (MD=-2.84, 95%CI:-3.45 to -2.23, Z=9.09, P<0.05) significantly differed between two groups. Subgroup analysis showed that the heterogeneity of operation time, intraoperative blood loss and length of postoperative hospital stay was mainly caused by the difficulty of laparoscopic hepatectomy.

Application of three-dimensional reconstruction in laparoscopic hepatectomy for liver cancer can improve the surgical safety and efficacy, shorten the operation time, reduce the intraoperative blood loss and lower the risk of postoperative complications.