Yamada Yohei, Hoshino Ken, Mori Teisaburo, Kawaida Miho, Abe Kiyotomo, Takahashi Nobuhiro, Fujimura Takumi, Kameyama Kaori, Kuroda Tatsuo
1 Department of Pediatric Surgery, Keio University School of Medicine , Tokyo, Japan .
2 Department of Pathology, Keio University School of Medicine , Tokyo, Japan .
J Laparoendosc Adv Surg Tech A. 2018 Sep;28(9):1152-1155. doi: 10.1089/lap.2017.0735. Epub 2018 Jun 15.
The curability of hepatoblastoma (HB) largely depends on the achievement of radical surgical resection, even for metastatic tumors. However, the extension of the metastatic tumor when viewed through an endoscope with the conventional white-light mode is often unclear. Advancements in imaging technology utilizing indocyanine green (ICG) have facilitated precise resection of metastatic HBs, owing to the longer retention of ICG in such lesions than in other normal tissues.
We utilized an endoscope loaded with the PINPOINT system (NOVADAQ Technologies, Inc., Ontario, Canada), which allows for real-time overlay visualization with the same focal range between the white-light mode and near-infrared mode. Metastatic HBs that have taken up ICG are visualized as an area of green color superimposed on a high-definition white-light image. A 19-year-old female who underwent liver transplantation for an unresectable HB 2 years earlier was noted to have metastases on the diaphragm and the pleura. Preoperative magnetic resonance imaging showed metastatic HBs on the right pleura extending from the ribs and the diaphragm. The margin of the metastatic tumor was more sharply demarcated by the PINPOINT system than that detected in the normal white-light mode. The tumor was successfully resected en bloc with real-time guidance utilizing the overlay image. The alphafetoprotein levels were normalized and have remained within normal limits in the 12 months since the operation.
Novel overlay imaging technology with ICG makes it possible to achieve real-time precise resection of metastatic HBs.
肝母细胞瘤（HB）的可治愈性很大程度上取决于能否实现根治性手术切除，即使是转移性肿瘤。然而，在传统白光模式下通过内窥镜观察时，转移性肿瘤的范围往往不清晰。利用吲哚菁绿（ICG）的成像技术进展有助于精确切除转移性HB，因为ICG在这些病变中的滞留时间比在其他正常组织中更长。
我们使用了配备PINPOINT系统（加拿大安大略省NOVADAQ Technologies公司）的内窥镜，该系统允许在白光模式和近红外模式之间以相同焦距进行实时叠加可视化。摄取了ICG的转移性HB在高清白光图像上显示为绿色叠加区域。一名19岁女性两年前因无法切除的HB接受了肝移植，被发现膈肌和胸膜有转移。术前磁共振成像显示右胸膜的转移性HB从肋骨和膈肌延伸。与正常白光模式下检测到的相比，PINPOINT系统更清晰地勾勒出转移性肿瘤的边界。利用叠加图像在实时引导下成功将肿瘤整块切除。术后12个月甲胎蛋白水平恢复正常并一直保持在正常范围内。
采用ICG的新型叠加成像技术能够实现转移性HB的实时精确切除。
