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吲哚菁绿荧光在腹腔镜超声辅助微创肝切除术中的应用。

Application of Indocyanine Green Fluorescence as an Adjuvant to Laparoscopic Ultrasound in Minimally Invasive Liver Resection.

机构信息

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.

出版信息

J Laparoendosc Adv Surg Tech A. 2021 May;31(5):517-523. doi: 10.1089/lap.2020.0895. Epub 2021 Mar 2.

Abstract

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.

摘要

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”。

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