Miyazaki Yoshihiro, Kurata Masanao, Oshiro Yukio, Shimomura Osamu, Takahashi Kazuhiro, Oda Tatsuya, Ohkohchi Nobuhiro
Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
Surg Case Rep. 2018 Nov 7;4(1):130. doi: 10.1186/s40792-018-0537-x.
Indocyanine green (ICG) can selectively accumulate in primary hepatocellular carcinoma (HCC) and its extrahepatic metastases. ICG fluorescence imaging is an extremely sensitive intraoperative tool for detecting HCC foci and can be used to detect impalpable tumors in laparoscopic surgery. Here, we report a case of a 75-year-old man who underwent peritoneal metastasis resection of HCC using a laparoscopic near-infrared imaging system and ICG fluorescence-navigated surgery.
A 75-year-old man was referred to our department for peritoneal metastasis resection of HCC. Two years before admission, he had undergone transarterial embolization and segmentectomy of segment 6 with open surgery for ruptured HCC. Computed tomography revealed a 12-mm peritoneal metastatic lesion on the abdominal wall near the cut surface of the liver. No other metastases were observed; resection of the solitary metastasis was scheduled. ICG (0.5 mg/kg body weight) was intravenously injected, 72 h preoperatively. An endoscopic, ICG near-infrared fluorescence imaging system revealed clear green fluorescence, indicating peritoneal metastasis of HCC on the abdominal wall. The tumor was resected with adequate surgical margin by partially resecting the liver and diaphragm, followed by histological confirmation as peritoneal metastasis of HCC. No recurrence was observed after 12 months of follow-up.
ICG fluorescence can be useful in laparoscopic surgery for identifying peritoneal metastasis.
吲哚菁绿（ICG）可选择性地在原发性肝细胞癌（HCC）及其肝外转移灶中蓄积。ICG荧光成像术是一种检测HCC病灶极为灵敏的术中工具，可用于在腹腔镜手术中检测触诊不到的肿瘤。在此，我们报告一例75岁男性患者，其使用腹腔镜近红外成像系统及ICG荧光导航手术进行了HCC腹膜转移灶切除术。
一名75岁男性因HCC腹膜转移灶切除术被转诊至我科。入院前两年，他因破裂性HCC接受了经动脉栓塞及开放手术下的肝6段切除术。计算机断层扫描显示在肝脏切面附近的腹壁上有一个12毫米的腹膜转移病灶。未观察到其他转移灶；计划对孤立转移灶进行切除。术前72小时静脉注射ICG（0.5毫克/千克体重）。一个内镜ICG近红外荧光成像系统显示出清晰的绿色荧光，表明腹壁上存在HCC腹膜转移。通过部分切除肝脏和膈肌，以足够的手术切缘切除肿瘤，随后经组织学证实为HCC腹膜转移。随访12个月未观察到复发。
ICG荧光在腹腔镜手术中对于识别腹膜转移可能有用。
