Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy.
IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France.
J Laparoendosc Adv Surg Tech A. 2021 May;31(5):517-523. doi: 10.1089/lap.2020.0895. Epub 2021 Mar 2.
Indocyanine green (ICG) fluorescence imaging has been extensively used in a variety of applications in visceral surgery. In minimally invasive liver resections, the detection of small superficial hepatic lesions using an intravenous injection of ICG before surgery represents a promising application. We analyzed 18 consecutive patients who underwent laparoscopic liver resection for superficial malignant tumors, namely 11 patients with hepatocellular carcinoma (HCC), 5 patients with colorectal liver metastases (CRLM), 1 patient with intrahepatic cholangiocarcinoma (ICC), and 1 patient with thyroid cancer metastasis, using ICG fluorescence as an adjuvant tool to intraoperative laparoscopic ultrasound (LUS). An optimal ICG 15-minute clearance retention rate (R15 < 10%) and ICG plasma disappearance rate (<18%/minute) were present in 11 patients (61.1%) and in 14 patients (77.7%), respectively. Liver tumors were 29 in total, including 14 HCCs (48.3%), 13 CRLMs (44.8%), 1 ICC (3.4%), and 1 thyroid cancer metastasis (3.4%). Twenty-nine tumors (100%) were correctly visualized with ICG/fluorescence, as compared with 21 tumors identified with LUS (72.4%). After complete liver mobilization, ICG staining allowed to identify more superficial lesions (early HCC and small CRLM) in posterolateral segments (Segments 6 and 7) as compared with LUS (14 versus 10 lesions). In addition, in segments usually treated laparoscopically (e.g., left lateral segments), ICG was superior to LUS (10 versus 6 lesions) to identify superficial early HCC in patients with macronodular cirrhosis. ICG visual feedback might substitute the tactile feedback of the hand and might in some cases act as a "booster" of LUS for superficial hepatic lesions.
吲哚菁绿（ICG）荧光成像是一种广泛应用于内脏手术的技术。在微创肝切除术中，术前静脉注射 ICG 检测小的表浅肝病灶是一种很有前途的应用。我们分析了 18 例连续接受腹腔镜肝切除术的患者，这些患者的肝表面恶性肿瘤包括 11 例肝细胞癌（HCC）、5 例结直肠癌肝转移（CRLM）、1 例肝内胆管细胞癌（ICC）和 1 例甲状腺癌转移。我们使用 ICG 荧光作为术中腹腔镜超声（LUS）的辅助工具。11 例患者（61.1%）的 15 分钟 ICG 清除保留率（R15<10%）和 14 例患者（77.7%）的 ICG 血浆清除率（<18%/分钟）均为最佳。肝脏肿瘤共有 29 个，包括 14 个 HCC（48.3%）、13 个 CRLM（44.8%）、1 个 ICC（3.4%）和 1 个甲状腺癌转移（3.4%）。与 21 个通过 LUS 识别的肿瘤相比，用 ICG/荧光共正确识别了 29 个肿瘤（100%）。在完全游离肝脏后，ICG 染色可在 LUS 下识别更多表浅的病变（早期 HCC 和小 CRLM）在后外侧段（第 6 和 7 段）（14 个 vs. 10 个病变）。此外，在通常采用腹腔镜治疗的肝段（如左外叶），ICG 比 LUS 更能识别有大结节性肝硬化的患者的表浅早期 HCC（10 个 vs. 6 个病变）。ICG 的视觉反馈可以替代手的触觉反馈，在某些情况下可以作为 LUS 检测肝表浅病变的“助推器”。
