Meta-analysis of the efficacy of laparoscopic partial nephrectomy assisted by 3Dprinting technology
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摘要: 目的:比较3D打印技术辅助腹腔镜下肾部分切除术与传统腹腔镜肾部分切除术治疗肾肿瘤的疗效。方法:检索各大数据库相关文献,由2名独立文献分析员进行质量评价及数据提取,利用Revman 5.3软件进行分析。结果:共纳入文献9篇,共计病例511例。与传统腹腔镜肾部分切除术相比,3D打印技术辅助腹腔镜下肾部分切除术手术时间[MD=-10.73,95%CI(-16.76,-4.70),P=0.000 5]及血流阻断时间[MD=-4.03,95%CI(-5.38,-2.69),P<0.000 01]更短,术中出血量更少[MD=-15.64,95%CI(-26.05,-5.23),P=0.003],并发症更少[OR=0.37,95%CI(0.21,0.67),P=0.001],切缘宽度更小[MD=-0.12,95%CI(-0.20,-0.04),P=0.004],住院时间更短[MD=-0.15,95%CI(-0.30,-0.01),P=0.04],在术后1个月肌酐[MD=0.14,95%CI(-0.63,0.92),P=0.72]、切缘阳性率[RD=-0.01,95%CI(-0.04,0.03),P=0.67]和胃肠功能恢复时间[MD=-0.10,95%CI(-0.24,0.04),P=0.14]方面两者效果相当。结论:与传统腹腔镜肾部分切除术相比,3D打印技术辅助腹腔镜下肾部分切除术能够缩短手术时间、减少血流阻断时间及术中出血量、降低并发症的发生、缩小切缘宽度、减少术后住院时间,在术后1个月血肌酐、切缘阳性和胃肠功能恢复时间上效果相当。但由于本研究纳入文献较少且质量不高,各研究之间异质性较大,需要更多高质量的随机对照研究以进一步证实该结论。Abstract: Objective: To compare the efficacy between laparoscopic partial nephrectomy assisted by 3 D printing technique and conventional laparoscopic partial nephrectomy in the treatment of renal tumors.Methods: The related literature of major databases was ready for retrieval by two independent literature analysts, then quality evaluation and data extraction were conducted. Revman 5.3 software was used to analyze the data.Results: A total of 9 articles were included, with a total of 511 cases. Compared with traditional laparoscopic partial nephrectomy, 3 D printing technology assisted laparoscopic partial nephrectomy has shorter operation time[MD=-10.73, 95%CI(-16.76,-4.70), P=0.000 5]and blood flow blocking time[MD=-4.03, 95%CI(-5.38,-2.69), P<0.000 01], less intraoperative blood loss[MD=-15.64, 95%CI(-26.05,-5.23), P=0.003], fewer complications[OR=0.37, 95%CI(0.21, 0.67), P=0.001], smaller resection margin width[MD=-0.12, 95%CI(-0.20,-0.04), P=0.004], shorter hospital stay[MD=-0.15, 95%CI(-0.30,-0.01), P=0.04], and equivalent results in terms of postoperative creatinine[MD=0.14, 95%CI(-0.63, 0.92), P=0.72], positive rate of resection margin[RD=-0.01, 95%CI(-0.04, 0.03), P=0.67], and recovery time of gastrointestinal function[MD=-0.10, 95%CI(-0.24, 0.04), P=0.14].Conclusion: Compared with traditional laparoscopic partial nephrectomy, laparoscopic partial nephrectomy assisted by 3 D printing technology can shorten operation time, reduce blood flow blocking time and intraoperative bleeding, reduce the incidence of complications, reduce the width of resection margin, reduce postoperative hospital stay, and has equivalent effect in terms of postoperative creatinine, positive resection margin and recovery time of gastrointestinal function. However, due to the small number and low quality of included literature in this study and the heterogeneity among studies, more high-quality randomized controlled studies are needed to further confirm this conclusion.
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Key words:
- 3D printing /
- laparoscopy /
- nephron sparing /
- partial nephrectomy /
- renal tumor /
- meta-analysis
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[1] Motzer RJ,Jonasch E,Agarwal N,et al.Kidney Cancer,Version 2.2017,NCCN Clinical Practice Guidelines in Oncology[J].J Natl Compr Canc Netw,2017,15(6):804-834.
[2] Kim SP,Murad MH,Thompson RH,et al.Comparative Effectiveness for Survival and Renal Function of Partial and Radical Nephrectomy for Localized Renal Tumors:A Systematic Review and Meta-Analysis[J].J Urol,2012.
[3] Rinott Mizrahi G,Freifeld Y,Klein I,et al.Comparison of Partial and Radical Laparascopic Nephrectomy:Perioperative and Oncologic Outcomes for Clinical T2 Renal Cell Carcinoma[J].J Endourol,2018,32(10):950-954.
[4] Nishi M,Kanaji S,Otake Y,et al.Quantitative comparison of operative skill using 2-and 3-dimensional monitors during laparoscopic phantom tasks[J].Surgery,2017,161(5):1334-1340.
[5] Arai K,Iwanaga S,Toda H,et al.Three-dimensional inkjet biofabrication based on designed images[J].Biofabrication,2011,3(3):034113.
[6] Michalski MH,Ross JS.The shape of things to come:3D printing in medicine[J].JAMA,2014,312(21):2213-2214.
[7] Soliman Y,Feibus AH,Baum N.3D Printing and Its Urologic Applications[J].Rev Urol,2015,17(1):20-24.
[8] Cacciamani GE,Okhunov Z,Meneses AD,et al.Impact of Three-dimensional Printing in Urology:State of the Art and Future Perspectives.A Systematic Review by ESUT-YAUWP Group[J].Eur Urol,2019,76(2):209-221.
[9] 曹健,朱帅,叶明佶,等.3D打印技术辅助腹腔镜下肾肿瘤冷冻消融术[J].中国微创外科杂志,2018,18(12):1118-1120.
[10] 黄建荣,邓小林,宋乐明,等.3D打印技术在肾脏肿瘤中的应用[J].当代医学,2016,22(3):148-149.
[11] 王锋,赵淼,马静.3 D打印技术在肾肿瘤治疗的应用[J].中国继续医学教育,2016,8(10):108-109.
[12] 韩兴涛,杨凌博,李小辉,等.3D打印技术在后腹腔镜下保留肾单位手术治疗肾肿瘤中应用研究[J].临床泌尿外科杂志,2017,32(11):866-869.
[13] 孙春山,束坤鹏,王灵点,等.3D打印技术在后腹腔镜下肾部分切除术中的应用研究[J].现代泌尿生殖肿瘤杂志,2019,11(1):6-10.
[14] 何惠斌,丁宁,于世超,等.肾肿瘤手术中3D打印技术的应用价值[J].吉林医学,2017,38(09):1694-1695.
[15] Fan G,Meng Y,Zhu S,et al.Three-dimensional printing for laparoscopic partial nephrectomy in patients with renal tumors[J].J Int Med Res,2019,47(9):4324-4332.
[16] Kyung YS,Kim N,Jeong IG,et al.Application of 3-D Printed Kidney Model in Partial Nephrectomy for Predicting Surgical Outcomes:A Feasibility Study[J].Clin Genitourin Cancer,2019,17(5):e878-e884.
[17] 刘小兵,吴天鹏,祝存海,等.3D打印技术在腹腔镜超选择性阻断保留肾单位手术中的应用[J].武汉大学学报(医学版),2019,40(6):936-941.
[18] 杨启维,干思舜,叶剑青,等.3D打印结合3D腹腔镜在部分内生型肾癌保留肾单位手术中的临床应用研究[J].中华泌尿外科杂志,2019,40(5):333-339.
[19] Ljungberg B,Bensalah K,Canfield S,et al.EAU guidelines on renal cell carcinoma:2014 update[J].Eur Urol,2015,67(5):913-924.
[20] Van Poppel H,Da Pozzo L,Albrecht W,et al.A Prospective,Randomised EORTC Intergroup Phase 3 Study Comparing the Oncologic Outcome of Elective Nephron-Sparing Surgery and Radical Nephrectomy for Low-Stage Renal Cell Carcinoma[J].Eur Urol,2011,59(4):543-552.
[21] Hung AJ,Cai J,Simmons MN,et al."Trifecta" in partial nephrectomy[J].J Urol,2013,189(1):36-42.
[22] Shao P,Tang L,Li P,et al.Precise segmental renal artery clamping under the guidance of dual-source computed tomography angiography during laparoscopic partial nephrectomy[J].Eur Urol,2012,62(6):1001-1008.
[23] Silberstein JL,Maddox MM,Dorsey P,et al.Physical models of renal malignancies using standard cross-sectional imaging and 3-dimensional printers:a pilot study[J].Urology,2014,84(2):268-272.
[24] Zhang Y,Ge HW,Li NC,et al.Evaluation of three Dimensional printing for laparoscopic paItial nephrectomy of renal tumors:a preliminary repon[J].World J Urol,2016,34(4):533-537.
[25] Powers MK,Lee BR,Silberstein J.Three-dimensional printing of surgical anatomy[J].Curr Opin Urol,2016,26(3):283-288.
[26] von Rundstedt FC,Scovell JM,Agrawal S,et al.Utility of patient-specific silicone renal models for planning and rehearsal of complex tumour resections prior to robot-assisted laparoscopic partial nephrectomy[J].BJU Int,2017,119(4):598-604.
[27] Lasser MS,Doscher M,Keehn A,et al.Virtual surgical planning:a novel aid to robot-assisted laparoscopic partial nephrectomy[J].J Endourol,2012,26(10):1372-1379.
[28] Ukimura O,Nakamoto M,Gill IS.Three-dimensional reconstruction of renovascular-tumor anatomy to facilitate zero-ischemia partial nephrectomy[J].Eur Urol,2012,61(1):211-217.
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