吲哚菁绿荧光导航在腹腔镜肝切除术中的临床价值

摘要/Abstract

摘要： 目的探讨吲哚菁绿(ICG)荧光导航在腹腔镜肝切除术(LH)中的临床价值。方法回顾2015年3月至2021年3月入院施行LH的PLC患者64例,其中男性40例,女性24例,平均年龄(56.2±9.8)岁。偏态、正态分布计量资料分别以Mann-Whitney U检验、独立t检验进行比较;计数资料以χ²检验进行比较。结果 64例PLC患者行ICG荧光导航22例(ICG组),其余42例为非ICG组,比较临床资料,ICG组、非ICG组手术时间为162(110,198)min、192(124,248)min,差异具有统计学意义(P<0.05);ICG组、非ICG组术中失血量为102(36,214)mL、208(98,402)mL,差异具有统计学意义(P<0.05);ICG组宽切缘(>10 mm)为21例(95.4%)、窄切缘(<10 mm)为1例(4.5%),非ICG组宽切缘为31例(73.8%)、窄切缘为11例(26.2%),差异具有统计学意义(P<0.05)。 22例ICG荧光导航患者术前给药14例,均为肝细胞癌;术中给药8例,均为胆管细胞癌。患者临床资料差异均不具有统计学意义(P>0.05)。术前给药肿瘤区见明亮荧光显影,正常肝脏组织无显影;术中给药在ICG注入后正常肝脏组织见均匀荧光显影,肿瘤区无显影。结论 ICG荧光导航在LH应用中是安全可行的,术前明确PLC病理类型有助于肿瘤切缘界定、精准手术导航:肝细胞癌选择术前ICG给药,胆管细胞癌选择术中ICG给药。

关键词: 原发性肝癌, 腹腔镜肝切除术, 吲哚菁绿, 荧光显像导航技术

Abstract: Objective To explore the clinical value of indocyanine green (ICG) fluorescence navigation in laparoscopic hepatectomy (LH). Methods 64 PLC patients admitted to hospital for LH from March 2015 to March 2021 were reviewed, including 40 males and 24 females, with an average age of (56.2±9.8) years. The measurement data of skewness and normal distribution were compared by Mann-Whitney U test and independent t test respectively Counting data were compared by χ² test. Results Among 64 PLC patients, ICG fluorescence navigation was performed in 22 cases (ICG group), and the other 42 cases were non-ICG group. Comparing the clinical data, the operation time of ICG group and non-ICG group was 162 (110, 198) min and 192 (124, 248) min, with statistical significance (P<0.05). The intraoperative blood loss of ICG group and non-ICG group was 102 (36, 214) mL and 208 (98, 402) mL, with statistical significance (P<0.05). There were 21 cases (95.4%) with wide cutting edge (>10 mm) and 1 case (4.5%) with narrow cutting edge (< 10 mm) in ICG group, 31 cases (73.8%) with wide cutting edge and 11 cases (26.2%) with statistical significance (P<0.05). Among 22 patients with ICG fluorescence navigation, 14 were given before operation, which were patients with hepatocellular carcinoma; Intraoperative administration was performed in 8 patients with cholangiocarcinoma. There was no significant difference in clinical data (P>0.05). Bright fluorescence imaging was seen in the tumor area before operation, but no imaging was found in normal liver tissue. After ICG injection, the normal liver tissue showed uniform fluorescence development, but the tumor area did not develop. Conclusion ICG fluorescence navigation is safe and feasible in the application of LH. Defining PLC pathological types before operation is helpful to define tumor margin and accurate surgical navigation: preoperative ICG is selected for hepatocellular carcinoma and intraoperative ICG is selected for cholangiocarcinoma.

Key words: Primary liver cancer, Laparoscopic hepatectomy, Indocyanine green, Fluorescence imaging navigation technology

姚韩, 王健东. 吲哚菁绿荧光导航在腹腔镜肝切除术中的临床价值[J]. 肝脏, 2021, 26(11): 1272-1275.

YAO Han, WANG Jian-dong. Clinical value of indocyanine green fluorescence navigation in laparoscopic hepatectomy[J]. Chinese Hepatolgy, 2021, 26(11): 1272-1275.

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