Matsumura Masaru, Seyama Yasuji, Ishida Hiroyuki, Nemoto Satoshi, Tani Keigo, Imamura Jun
Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
Department of Hepatology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
Surg Case Rep. 2021 Jan 13;7(1):18. doi: 10.1186/s40792-020-01101-7.
Bile duct tumor thrombus (BDTT) is one of the features of advanced hepatocellular carcinoma (HCC). In the resection of HCC with BDTT, it is important to detect the BDTT tip to decide the appropriate point of bile duct division. In this regard, the efficacy of indocyanine green (ICG) fluorescence navigation has been confirmed for the detection of HCC, whereas its utility for BDTT has not yet been reported. Herein, we describe our experience with right hepatectomy for HCC with BDTT using ICG fluorescence navigation.
A 72-year-old woman had experienced local recurrences of HCC after radiofrequency ablation, with BDTT reaching the confluence of the right anterior branch and posterior branch. Right hepatectomy was planned, and 2.5 mg of ICG was injected one day before surgery. After transection of the liver parenchyma, the right liver was connected with only the right hepatic duct. ICG fluorescence imaging visualized the tip of BDTT in the bile duct with clear contrast; the proximal side (hepatic side) of the right hepatic duct showed stronger fluorescence than the distal side (duodenal side). The bile duct was divided at the distal side of the BDTT border, and the tip of BDTT was recognized into the resected right hepatic duct without laceration. The patient had an uneventful postoperative course and currently lives without recurrences for 6 months.
ICG fluorescence navigation assisted in the precise resection of the bile duct in HCC with BDTT.
胆管肿瘤血栓（BDTT）是晚期肝细胞癌（HCC）的特征之一。在切除伴有BDTT的HCC时，检测BDTT尖端以确定胆管离断的合适位置很重要。在这方面，吲哚菁绿（ICG）荧光导航检测HCC的有效性已得到证实，但其在BDTT中的应用尚未见报道。在此，我们描述了使用ICG荧光导航对伴有BDTT的HCC行右肝切除术的经验。
一名72岁女性在射频消融术后出现HCC局部复发，BDTT延伸至右前支和后支汇合处。计划行右肝切除术，术前一天注射2.5mg ICG。肝实质离断后，右肝仅通过右肝管相连。ICG荧光成像清晰地显示了胆管内BDTT的尖端；右肝管近端（肝侧）的荧光比远端（十二指肠侧）更强。在BDTT边界的远端离断胆管，BDTT尖端完整地被识别于切除的右肝管内。患者术后恢复顺利，目前已无复发存活6个月。
ICG荧光导航有助于精确切除伴有BDTT的HCC的胆管。
