腹腔镜辅助胃癌根治术中应用吲哚菁绿近红外荧光成像系统探测前哨淋巴结。
Indocyanine green injection for detecting sentinel nodes using color fluorescence camera in the laparoscopy-assisted gastrectomy.
机构信息
Department of Surgery, Center for Digestive Diseases, International University of Health and Welfare, Mita Hospital, Japan.
出版信息
J Gastroenterol Hepatol. 2012 Apr;27 Suppl 3:29-33. doi: 10.1111/j.1440-1746.2012.07067.x.
BACKGROUND AND AIM
We seek for the accurate and simple method for detecting sentinel nodes of gastric cancer which can be popularized in community hospitals. The indocyanine green (ICG) fluorescence-guided method is reported to be sensitive. However, the ordinal fluorescence cameras have gray scale imaging and require a dark room. We have developed a new device, Hyper Eye Medical System (HEMS) which can simultaneously detect color and near-infrared rays and can be used under room light. This study was planned to examine whether submucosal injection of 0.5 mL × 4 of 50 µg/mL ICG on the day before operation is the adequate administration for detecting sentinel nodes using HEMS in the gastric cancer surgery.
METHODS
The patients underwent gastrectomy for clinical T1a (mucosa)-T2 (muscularis propria) and clinical N0 were enrolled in the present study. As a preliminary trial, one case each of the ICG 25 and 100 µg/mL, injected on the day before operation and intraoperative injection, was examined. Then, 10 cases injected 50 µg/mL ICG on the day before operation were examined.
RESULTS
The ICG fluorescence of the patient injected 100 µg/mL was too intense and that of the patient injected 25 µg/mL was too faint. Sentinel lymph nodes were detected in all of 10 cases injected 50 µg/mL, the day before operation and number of sentinel lymph nodes per patient was 3.6 ± 2.1. Metastasis was observed in one case. All of ICG fluorescence-positive sentinel nodes were positive for the metastasis. In the patient who underwent intraoperative injection, sentinel lymphatic basins could be identified.
CONCLUSION
The present study shows that HEMS-guided abdominal surgery is feasible under room light. Submucosal injection of 0.5 mL × 4 of 50 µg/mL ICG on the day before operation is the adequate administration for detecting sentinel nodes using HEMS in the gastric cancer surgery.
背景与目的
我们旨在寻找一种准确且简便的方法来检测胃癌的前哨淋巴结，使其能够在社区医院得到推广。吲哚菁绿（ICG）荧光引导法被认为具有较高的敏感性。然而，这种方法需要使用灰度成像的序贯荧光摄像机，并且需要在暗室中进行。我们开发了一种新的设备，即 Hyper Eye 医疗系统（HEMS），它可以同时检测颜色和近红外光，并且可以在室内光照下使用。本研究旨在检验在术前一天行黏膜下注射 0.5 mL×4 支、50 µg/mL 的 ICG 是否足以通过 HEMS 检测胃癌手术中的前哨淋巴结。
方法
本研究纳入了接受胃癌根治术的临床 T1a（黏膜）-T2（固有肌层）和临床 N0 患者。作为初步试验，我们分别对术前一天和术中注射 ICG 浓度为 25 µg/mL 和 100 µg/mL 的各 1 例患者进行了检验。然后，我们对术前一天注射 50 µg/mL ICG 的 10 例患者进行了检验。
结果
注射 100 µg/mL ICG 的患者荧光过强，而注射 25 µg/mL ICG 的患者荧光过弱。在术前一天注射 50 µg/mL ICG 的 10 例患者中均检测到了前哨淋巴结，每位患者的前哨淋巴结数量为 3.6±2.1。1 例患者发生了转移。所有 ICG 荧光阳性的前哨淋巴结均发生了转移。在术中注射的患者中，也可以识别前哨淋巴结区域。
结论
本研究表明，HEMS 引导的腹部手术可以在室内光照下进行。在胃癌手术中，术前一天行黏膜下注射 0.5 mL×4 支、50 µg/mL 的 ICG 是通过 HEMS 检测前哨淋巴结的有效方法。
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