Morozov Andrey O, Alyaev Yuri G, Rapoport Leonid M, Tsarichenko Dmitrii G, Bezrukov Eugene A, Butnaru Denis V, Sirota Eugene S
Department of Urology, I.M. Sechenov First Moscow State Medical University, Moscow - Russia.
Urologia. 2017 Aug 1;84(3):197-202. doi: 10.5301/uj.5000235. Epub 2017 May 16.
Fluorescence imaging with indocyanine green is used in urology for the detection of sentinel lymph nodes and identification of prostate margins in radical prostatectomy for delineation of resection zone and selective clamping of vessels in partial nephrectomy; for identification and evaluation of length of ureteral strictures; for assessment of perfusion and viability of anastomoses during reconstructive stage of cystectomy. Safety of this technique is proven, while its diagnostic value and usefulness is still controversial.
This pilot study of using the SPY Elite Fluorescence Imaging System for diagnostics was performed in the I.M. Sechenov First Moscow State Medical University. Ten patients were enrolled: four patients underwent retropubic RP and lymph node dissection, five patients underwent partial nephrectomy, and one patient underwent ureteroplasty. Fluorophore was injected transrectally with TRUS guidance during RP in order to assess the lymph nodes. During partial nephrectomy, the compound was injected intravenously to differentiate the tumor from parenchyma by its blood supply. During ureteroplasty, the indocyanine green solution was injected into the renal pelvis to dye the ureter and locate the stricture.
Sensitivity of this technique for visualization of sentinel lymph nodes was 100%, and specificity was 73.3%. In patients who underwent partial nephrectomy, all lesions were malignant and hypofluorescent when compared with healthy parenchyma. SPY allowed us to determine the location and extension of the stricture during ureteroplasty. No hypersensitivity reactions or complications were observed during injection of the compound.
吲哚菁绿荧光成像在泌尿外科中用于前哨淋巴结的检测以及根治性前列腺切除术中前列腺边缘的识别，以勾勒切除区域并在部分肾切除术中选择性夹闭血管；用于输尿管狭窄长度的识别和评估；用于膀胱切除重建阶段吻合口灌注和活力的评估。该技术的安全性已得到证实，但其诊断价值和实用性仍存在争议。
这项关于使用SPY Elite荧光成像系统进行诊断的初步研究在莫斯科第一国立谢马什克医科大学进行。纳入了10名患者：4名患者接受耻骨后根治性前列腺切除术和淋巴结清扫术，5名患者接受部分肾切除术，1名患者接受输尿管成形术。在根治性前列腺切除术中，在经直肠超声引导下经直肠注射荧光团以评估淋巴结。在部分肾切除术中，静脉注射该化合物以通过其血供将肿瘤与实质区分开来。在输尿管成形术中，将吲哚菁绿溶液注入肾盂以对输尿管进行染色并定位狭窄部位。
该技术对前哨淋巴结可视化的敏感性为100%，特异性为73.3%。在接受部分肾切除术的患者中，与健康实质相比，所有病变均为恶性且荧光较弱。SPY使我们能够在输尿管成形术中确定狭窄的位置和范围。注射该化合物期间未观察到过敏反应或并发症。
