Guigard Sébastien, Triponez Frédéric, Bédat Benoit, Vidal-Fortuny Jordi, Licker Marc, Karenovics Wolfram
Faculty of Medicine, Department of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland.
Faculty of Medicine, Department of Anaesthesiology, University Hospitals of Geneva, Geneva, Switzerland.
Interact Cardiovasc Thorac Surg. 2017 Nov 1;25(5):703-709. doi: 10.1093/icvts/ivx225.
Segmentectomy by video-assisted thoracoscopic surgery (VATS) permits anatomical resection for diagnosis and treatment of small lung nodules but requires that intersegmental planes and segmental vessels be identified accurately. Near-infrared angiography with systemic injection of indocyanine green (ICG) can precisely identify the intersegmental plane. The purpose of this study was to confirm the usefulness of ICG angiography during VATS segmentectomy.
We retrospectively reviewed the records of 22 consecutive patients who underwent VATS segmentectomy performed with near-infrared angiography between November 2014 and October 2015. Segments were localized and anatomical vascular supply was identified on preoperative computed tomography scans. VATS segmentectomy was performed using an anterior approach with 2 ports and 1 non-spreading minithoracotomy, with ICG injected systemically after arterial ligation.
VATS was feasible for all 22 segmentectomies, and in all patients, the intersegmental plane was identified accurately by ICG angiography. This angiography method was also useful in patients whose anatomical vascular segmentation was difficult to identify and, in a few patients, to assess the distribution of an artery before sectioning, to determine the vascular supply of the remaining lung and to distinguish between segmental and intersegmental veins. The postoperative course was uneventful for 18 patients and complicated for 2 patients who had prolonged air leak (10 and 15 days) with pneumonia, 1 patient with gastroparesis and 1 with colonic ileus. The drain was removed before the 3rd postoperative day in all but 2 patients, and the mean hospital stay was 5.4 ± 4.5 days. Anatomopathological examination indicated that 4 benign lesions and 18 primary lung cancers were completely removed, including 14 that were Stage IA, 2 Stage IIA and 2 Stage IIIA.
Indocyanine green angiography provides technical support for identifying the intersegmental plane and the vasculature during VATS segmentectomy. It contributes to the quality of diagnostic and therapeutic excisions of small nodules that are often not visible and not palpable during VATS.
电视辅助胸腔镜手术（VATS）下的肺段切除术能够对小肺结节进行解剖性切除以用于诊断和治疗，但这需要准确识别肺段间平面和肺段血管。通过全身注射吲哚菁绿（ICG）进行近红外血管造影能够精确识别肺段间平面。本研究的目的是证实ICG血管造影在VATS肺段切除术中的实用性。
我们回顾性分析了2014年11月至2015年10月期间连续22例行VATS肺段切除术并进行近红外血管造影的患者的记录。术前通过计算机断层扫描确定肺段位置并识别解剖学血管供应。VATS肺段切除术采用前路双孔加1个非撑开式小切口开胸术式，在动脉结扎后全身注射ICG。
22例肺段切除术均成功实施VATS，所有患者均通过ICG血管造影准确识别了肺段间平面。这种血管造影方法对于难以识别解剖学血管分割的患者也很有用，并且在少数患者中，有助于在切断前评估动脉分布、确定剩余肺组织的血管供应以及区分肺段静脉和肺段间静脉。18例患者术后恢复顺利，2例患者出现并发症，分别为气胸持续漏气时间延长（10天和15天）并伴有肺炎，1例患者出现胃轻瘫，1例患者出现结肠梗阻。除2例患者外，所有患者均在术后第3天前拔除引流管，平均住院时间为5.4±4.5天。解剖病理学检查表明，4例良性病变和18例原发性肺癌均被完整切除，其中14例为IA期，2例为IIA期，2例为IIIA期。
吲哚菁绿血管造影为VATS肺段切除术中识别肺段间平面和脉管系统提供了技术支持。它有助于提高对VATS期间通常不可见且不可触及的小结节的诊断性和治疗性切除质量。
