Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan.
Department of Innovative Cancer Immunotherapy, Gunma University Graduate School of Medicine, Gunma, Japan.
J Hepatobiliary Pancreat Sci. 2020 Jul;27(7):371-379. doi: 10.1002/jhbp.728. Epub 2020 Mar 17.
BACKGROUND/PURPOSE: Right hepatic vein (RHV) drainage area resection is performed for intrahepatic tumors. However, borders of RHV drainage areas are difficult to identify. We evaluated the usefulness of indocyanine green (ICG) fluorescent images to identify the borders for RHV drainage area resection.
From January 2016 to May 2019, we included 12 patients who underwent hepatic resection of the RHV drainage area, which was evaluated using ICG fluorescence images after clamping the RHV and with or without clamping the proper hepatic artery (PHA). The resected liver volume was compared with the preoperative simulated resected liver volume by 3-dimensional computed tomography.
Eleven borders of the RHV drainage area between the middle hepatic vein (MHV) or inferior RHV drainage area were confirmed using ICG fluorescent images in 12 patients. The borders were observable by only clamping the RHV. In one patient, the border could not be identified because there was a shunt between the RHV and MHV at the peripheral area. Resected liver volume was significantly correlated with the results of preoperative simulation.
The RHV drainage area resection could be one of the options of hepatic resection for the tumor involving the root of the RHV. ICG fluorescent imaging in hepatic resection of the RHV drainage area is useful for determining areas of liver congestion and clamping the PHA is not always necessary.
背景/目的：右肝静脉（RHV）引流区切除术用于治疗肝内肿瘤。然而，RHV 引流区的边界难以确定。我们评估了吲哚菁绿（ICG）荧光图像在识别 RHV 引流区切除边界中的作用。
自 2016 年 1 月至 2019 年 5 月，我们纳入了 12 例接受 RHV 引流区肝切除术的患者，在夹闭 RHV 后并在夹闭或不夹闭肝固有动脉（PHA）的情况下使用 ICG 荧光图像评估 RHV 引流区。通过三维计算机断层扫描比较切除的肝体积与术前模拟切除的肝体积。
在 12 例患者中，11 例 RHV 引流区与中肝静脉（MHV）或下 RHV 引流区之间的边界通过 ICG 荧光图像得到确认。仅夹闭 RHV 即可观察到边界。在 1 例患者中，由于 RHV 和 MHV 在周边区域之间存在分流，边界无法识别。切除的肝体积与术前模拟结果显著相关。
RHV 引流区切除术可能是 RHV 根部肿瘤肝切除术的一种选择。ICG 荧光成像在 RHV 引流区肝切除术中有助于确定肝充血区域，夹闭 PHA 并不总是必要的。
