Ichinose Junji, Matsuura Yosuke, Nakao Masayuki, Okumura Sakae, Mun Mingyon
Department of Thoracic Surgical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
Kyobu Geka. 2019 Jul;72(7):501-508.
We investigated the feasibility and efficacy of thoracoscopic segmentectomy using 3-dimensional computed tomography( 3D-CT) and indocyanine-green( ICG) fluorescence navigation.
ICG fluorescence-navigated thoracoscopic segmentectomy was performed in 149 patients during 2013 and 2017. Each patient underwent preoperative evaluation by thin-section enhanced CT, which provided 3-dimensional simulations of vascular and bronchial structures. During the procedure, low-dose ICG( 0.15~0.25 mg/kg) was injected systemically after the target segmental pulmonary arteries and bronchus were divided. Under near-infrared thoracoscopic guidance, an intersegmental plane was clearly observed as a border between dark target region and bright residual region. The ICG fluorescent line was marked by electrocautery, followed by division of lung parenchyma along the line by endoscopic staples.
An intersegmental line was visible in 98% of patients by ICG fluorescence navigation. No ICG-related adverse events occurred. No operative mortality was observed and morbidity rate was 8.7%. The 5-year overall survival rate and the 5-year recurrence free probability of 101 patients with primary lung cancer were 92% and 98%, respectively. Local recurrence at the resected site occurred in no patient with lung cancer and 1 patient with pulmonary metastasis.
Thoracoscopic segmentectomy using 3D-CT and ICG fluorescence navigation is a useful therapeutic option.
我们研究了使用三维计算机断层扫描（3D-CT）和吲哚菁绿（ICG）荧光导航进行胸腔镜肺段切除术的可行性和疗效。
2013年至2017年期间，对149例患者进行了ICG荧光导航胸腔镜肺段切除术。每位患者均接受了薄层增强CT的术前评估，该检查提供了血管和支气管结构的三维模拟图像。在手术过程中，在离断目标肺段动脉和支气管后，全身注射低剂量ICG（0.15~0.25 mg/kg）。在近红外胸腔镜引导下，可清晰观察到节段间平面，其为深色目标区域与亮色残留区域之间的边界。用电子烧灼标记ICG荧光线，然后用内镜吻合器沿该线离断肺实质。
通过ICG荧光导航，98%的患者可见节段间线。未发生与ICG相关的不良事件。未观察到手术死亡病例，发病率为8.7%。101例原发性肺癌患者的5年总生存率和5年无复发生存率分别为92%和98%。肺癌患者和肺转移患者中均无切除部位局部复发情况。
使用3D-CT和ICG荧光导航的胸腔镜肺段切除术是一种有效的治疗选择。
