Okumura Norihito
Department of Thoracic Surgery, Kurashiki Central Hospital, Kurashiki, Japan.
Kyobu Geka. 2019 Jul;72(7):496-500.
Recently, reports of segmentectomy using indocyanine green (ICG) infrared thoracoscopy is gradually increasing. This method enables the clear identification of intersegmental line without the effect of collateral air drift, and seems useful especially for complex segmentectomy. On the other hand, the division of intersegmental plane using auto stapler recently seems to have some evidence of superiority of avoiding air-leakage over that using electrocautery. For these reasons, we have performed thoracoscopic stapler-based segmentectomy using ICG-infrared thoracoscopy.
Consecutive 92 patients who underwent thoracoscopic segmentectomy using ICG-infrared thoracoscopy between July, 2016 and March, 2019 in our hospital were retrospectively evaluated.
Forty-seven patients were men, and the average age was 70 years (range, 30 to 90). The most target illness was primary lung cancer( 80.4%), but metastatic pulmonary tumor or inflammatory lung disease were also involved. Fifty-four patients (58.7%) underwent complex segmentectomy. Intersegmental borders were generally well recognized with ICG-infrared thoracoscopy. Only 2 cases needed small thoracotomy, but all the cases were completed segmentectomy. Neither 30-day nor 90-day mortality was observed. Postoperative complications [Common Terminology Criteria for Adverse Events( CTCAE)≥Grade 2] were seen in 11 patients( 12.0%). There was no complication related with the use of ICG. Postoperative air-leakage was seen in 2 patients( 2.2%). There was no case of delayed air-leakage who needed reinsertion of chest tube. Duration of chest tube insertion was 1 to 7 days after surgery( median 3 days). Length of stay after surgery was 3 to 18 ( median 5) days.
Thoracoscopic stapler-based segmentectomy using ICG-infrared thoracoscopy seems feasible and useful surgical procedure.
最近，关于使用吲哚菁绿（ICG）红外胸腔镜进行肺段切除术的报道逐渐增多。该方法能够清晰识别肺段间平面，不受侧支气流的影响，似乎特别适用于复杂的肺段切除术。另一方面，最近使用自动缝合器分离肺段间平面似乎比使用电灼术在避免漏气方面具有一些优势。基于这些原因，我们开展了使用ICG红外胸腔镜的胸腔镜缝合器辅助肺段切除术。
对2016年7月至2019年3月在我院接受ICG红外胸腔镜辅助胸腔镜肺段切除术的92例连续患者进行回顾性评估。
47例为男性，平均年龄70岁（范围30至90岁）。最常见的目标疾病是原发性肺癌（80.4%），但也包括转移性肺肿瘤或炎性肺疾病。54例（58.7%）患者接受了复杂的肺段切除术。ICG红外胸腔镜通常能很好地识别肺段间边界。仅2例需要小切口开胸，但所有病例均完成了肺段切除术。未观察到30天或90天死亡率。11例患者（12.0%）出现术后并发症[不良事件通用术语标准（CTCAE）≥2级]。未发生与使用ICG相关的并发症。2例患者（2.2%）出现术后漏气。没有延迟漏气需要重新插入胸管的病例。胸管留置时间为术后1至7天（中位时间3天）。术后住院时间为3至18天（中位时间5天）。
使用ICG红外胸腔镜的胸腔镜缝合器辅助肺段切除术似乎是一种可行且有用的手术方法。
