Ishizawa Takeaki, Saiura Akio, Kokudo Norihiro
Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Japan;; Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Japan ;
Hepatobiliary Surg Nutr. 2016 Aug;5(4):322-8. doi: 10.21037/hbsn.2015.10.01.
In hepatobiliary surgery, the fluorescence and bile excretion of indocyanine green (ICG) can be used for real-time visualization of biological structure. Fluorescence cholangiography is used to obtain fluorescence images of the bile ducts following intrabiliary injection of 0.025-0.5 mg/mL ICG or intravenous injection of 2.5 mg ICG. Recently, the latter technique has been used in laparoscopic/robotic cholecystectomy. Intraoperative fluorescence imaging can be used to identify subcapsular hepatic tumors. Primary and secondary hepatic malignancy can be identified by intraoperative fluorescence imaging using preoperative intravenous injection of ICG through biliary excretion disorders that exist in cancerous tissues of hepatocellular carcinoma (HCC) and in non-cancerous hepatic parenchyma around adenocarcinoma foci. Intraoperative fluorescence imaging may help detect tumors to be removed, especially during laparoscopic hepatectomy, in which visual inspection and palpation are limited, compared with open surgery. Fluorescence imaging can also be used to identify hepatic segments. Boundaries of hepatic segments can be visualized following injection of 0.25-2.5 mg/mL ICG into the portal veins or by intravenous injection of 2.5 mg ICG following closure of the proximal portal pedicle toward hepatic regions to be removed. These techniques enable identification of hepatic segments before hepatectomy and during parenchymal transection for anatomic resection. Advances in imaging systems will increase the use of fluorescence imaging as an intraoperative navigation tool that can enhance the safety and accuracy of open and laparoscopic/robotic hepatobiliary surgery.
在肝胆外科手术中,吲哚菁绿(ICG)的荧光和胆汁排泄可用于生物结构的实时可视化。荧光胆管造影用于在胆管内注射0.025 - 0.5 mg/mL ICG或静脉注射2.5 mg ICG后获取胆管的荧光图像。最近,后一种技术已用于腹腔镜/机器人胆囊切除术。术中荧光成像可用于识别肝包膜下肿瘤。原发性和继发性肝恶性肿瘤可通过术中荧光成像来识别,方法是术前静脉注射ICG,利用肝细胞癌(HCC)癌组织及腺癌病灶周围非癌性肝实质中存在的胆汁排泄障碍。术中荧光成像可能有助于检测待切除的肿瘤,特别是在腹腔镜肝切除术中,与开放手术相比,腹腔镜肝切除术中的视觉检查和触诊受限。荧光成像还可用于识别肝段。在向门静脉注射0.25 - 2.5 mg/mL ICG后,或在向待切除肝区关闭近端门静脉蒂后静脉注射2.5 mg ICG,可使肝段边界可视化。这些技术能够在肝切除术前以及在进行解剖性切除的实质横断过程中识别肝段。成像系统的进步将增加荧光成像作为术中导航工具的使用,这可以提高开放和腹腔镜/机器人肝胆手术的安全性和准确性。