Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
Surg Endosc. 2022 Feb;36(2):1293-1301. doi: 10.1007/s00464-021-08404-2. Epub 2021 Mar 8.
Laparoscopic right posterior hepatectomy is considered difficult on the basis of the surgery difficulty scoring system. In this study, we evaluated the safety and effectiveness of the technical application of indocyanine green (ICG) fluorescence imaging-guided laparoscopic right posterior hepatectomy.
Twenty-six patients who underwent ICG fluorescence imaging-guided laparoscopic right posterior hepatectomy at Hepatobiliary and Pancreatic Surgery Department of Zhongnan Hospital, Wuhan University, from June 2018 to December 2019, were included. The influence of patient position, trocar placement, hepatic inflow occlusion, central venous pressure (CVP), and the ICG fluorescence imaging-guided method were analyzed.
In 17 patients, the left lateral position was maintained when the main tumor was in the S7, and in the remaining nine patients, the supine position was maintained with the right side of the body raised when the main tumor was in the S6. Ten patients who underwent preoperative injection of ICG were successfully developed for nonanatomical hepatectomy. Sixteen patients received intraoperative ICG injection for anatomical hepatectomy (2 cases had positive imaging findings, 14 cases had negative imaging findings, and 2 cases had failed imaging findings). All patients underwent the Pringle maneuver during the procedure. Four patients were preset with subhepatic vena cava blocking and one patient with suprahepatic inferior vena cava blocking. CVP was controlled at 3.00 ± 0.63 (mean ± SD) cmHO. The operative time was 216.14 ± 52.05 min, and the bleeding volume was 128.57 ± 75.55 ml. Four patients had Clavien-Dindo level I complications, and one had level III complications. Postoperative hospitalization duration was 6.19 ± 1.40 days. There were 14 patients with hepatocellular carcinoma, 9 with metastatic liver malignancies, 2 with hepatic hemangioma, 1 with focal nodular hyperplasia of the liver, and 10 with hepatitis B liver cirrhosis.
ICG fluorescence imaging guidance could be helpful for the safe implementation of laparoscopic right posterior hepatectomy.
根据手术难度评分系统，腹腔镜右后叶肝切除术被认为具有一定难度。本研究旨在评估吲哚菁绿（ICG）荧光成像引导下腹腔镜右后叶肝切除术的安全性和有效性。
回顾性分析 2018 年 6 月至 2019 年 12 月武汉大学中南医院肝胆胰外科 26 例行 ICG 荧光成像引导腹腔镜右后叶肝切除术患者的临床资料，分析患者体位、Trocar 位置、肝血流阻断、中心静脉压（CVP）、ICG 荧光成像引导方法等对手术的影响。
26 例患者中，主病灶位于 S7 时，17 例患者取左侧卧位，主病灶位于 S6 时，9 例患者取仰卧位，右侧抬高。10 例行术前 ICG 注射的患者均成功施行非解剖性肝切除术，16 例行术中 ICG 注射的患者行解剖性肝切除术（2 例有阳性成像结果，14 例有阴性成像结果，2 例有失败成像结果）。所有患者术中均行 Pruingle 操作，4 例预置肝下下腔静脉阻断，1 例预置肝上下腔静脉阻断。术中 CVP 控制在 3.00±0.63cmH2O。手术时间为 216.14±52.05min，术中出血量为 128.57±75.55ml。4 例患者发生 Clavien-DindoⅠ级并发症，1 例患者发生Ⅲ级并发症。术后住院时间为 6.19±1.40d。14 例患者为肝细胞癌，9 例为转移性肝癌，2 例为肝血管瘤，1 例为局灶性结节性增生，10 例为乙型肝炎肝硬化。
ICG 荧光成像引导有助于安全施行腹腔镜右后叶肝切除术。
