Yamasaki Takeshi, Tamada Satoshi, Kato Minoru, Otoshi Taiyo, Tanaka Hisao, Iguchi Taro, Nakatani Tatsuya
Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan.
Can J Urol. 2018 Dec;25(6):9606-9613.
Recently, the use of indocyanine green (ICG) with near infrared fluorescence (NIRF) imaging has emerged as an alternative technique for the real-time delineation of resection margins during partial nephrectomy (PN). We aimed to assess the feasibility of using NIRF imaging with ICG during laparoscopic partial nephrectomy (LPN) to delineate the margin between normal renal parenchyma and renal cortical tumors.
A retrospective comparison of real-time tumor margin identification and operative outcomes was conducted for 83 patients who underwent LPN with NIRF imaging (IMAGE1 system) and 74 patients who did not.
Tumor margins were identified in 82% of cases in the NIRF group, with a rate of 79% for the clear cell renal carcinoma cases only. Volume of blood loss was higher for the NIRF than normal imaging group (p = 0.015), while the warm ischemia time was significantly shorter (p < 0.01) for the NIRF group. There was no significant difference in the pre to postoperative change in estimated glomerular filtration rate (p = 0.38) or rate of severe complications (Clavien grade ≥ 3; p = 0.88). The rate of positive surgical margins was comparable between the groups (3%; p = 0.91).
NIRF imaging with ICG during LPN was safe and feasible, although the surgical outcomes with NIRF alone was not significantly superior to the ones with conventional methods.
最近，吲哚菁绿（ICG）与近红外荧光（NIRF）成像技术的联合使用已成为肾部分切除术（PN）中实时界定手术切缘的一种替代技术。我们旨在评估在腹腔镜肾部分切除术（LPN）期间使用ICG进行NIRF成像以界定正常肾实质与肾皮质肿瘤之间切缘的可行性。
对83例行LPN并接受NIRF成像（IMAGE1系统）的患者和74例未接受该成像的患者进行了实时肿瘤切缘识别及手术结果的回顾性比较。
NIRF组82%的病例中识别出肿瘤切缘，仅透明细胞肾细胞癌病例的识别率为79%。NIRF组的失血量高于普通成像组（p = 0.015），而NIRF组的热缺血时间显著更短（p < 0.01）。两组间术前至术后估计肾小球滤过率的变化（p = 0.38）或严重并发症发生率（Clavien分级≥3级；p = 0.88）无显著差异。两组间手术切缘阳性率相当（3%；p = 0.91）。
LPN期间使用ICG进行NIRF成像是安全可行的，尽管仅使用NIRF的手术结果并不显著优于传统方法。
