Hutteman M, van der Vorst J R, Mieog J S D, Bonsing B A, Hartgrink H H, Kuppen P J K, Löwik C W G M, Frangioni J V, van de Velde C J H, Vahrmeijer A L
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Eur Surg Res. 2011;47(2):90-7. doi: 10.1159/000329411. Epub 2011 Jun 30.
Intraoperative visualization of pancreatic tumors has the potential to improve radical resection rates. Intraoperative visualization of the common bile duct and bile duct anastomoses could be of added value. In this study, we explored the use of indocyanine green (ICG) for these applications and attempted to optimize injection timing and dose.
Eight patients undergoing a pancreaticoduodenectomy were injected intravenously with 5 or 10 mg ICG. During and after injection, the pancreas, tumor, common bile duct and surrounding organs were imaged in real time using the Mini-FLARE™ near-infrared (NIR) imaging system.
No clear tumor-to-pancreas contrast was observed, except for incidental contrast in 1 patient. The common bile duct was clearly visualized using NIR fluorescence, within 10 min after injection, with a maximal contrast between 30 and 90 min after injection. Patency of biliary anastomoses could be visualized due to biliary excretion of ICG.
No useful tumor demarcation could be visualized in pancreatic cancer patients after intravenous injection of ICG. However, the common bile duct and biliary anastomoses were clearly visualized during the observation period. Therefore, these imaging strategies could be beneficial during biliary surgery in cases where the surgical anatomy is aberrant or difficult to identify.
胰腺肿瘤的术中可视化有提高根治性切除率的潜力。胆总管及胆管吻合口的术中可视化可能具有附加价值。在本研究中，我们探索了吲哚菁绿（ICG）在这些应用中的使用，并试图优化注射时间和剂量。
8例行胰十二指肠切除术的患者静脉注射5或10mg ICG。注射期间及之后，使用Mini-FLARE™近红外（NIR）成像系统对胰腺、肿瘤、胆总管及周围器官进行实时成像。
除1例患者出现偶然的对比外，未观察到明显的肿瘤与胰腺之间的对比。注射后10分钟内，使用近红外荧光可清晰显示胆总管，注射后30至90分钟之间对比最大。由于ICG的胆汁排泄，可观察到胆管吻合口的通畅情况。
静脉注射ICG后，胰腺癌患者中未观察到有用的肿瘤边界划分。然而，在观察期内胆总管及胆管吻合口清晰可见。因此，在手术解剖结构异常或难以识别的胆道手术中，这些成像策略可能有益。
