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吲哚菁绿荧光成像在小儿肝母细胞瘤诊治中的优势:初步经验

The Advantages of Indocyanine Green Fluorescence Imaging in Detecting and Treating Pediatric Hepatoblastoma: A Preliminary Experience.

作者信息

Cho Yu Jeong, Namgoong Jung-Man, Kwon Hyun Hee, Kwon Yong Jae, Kim Dae Yeon, Kim Seong Chul

机构信息

Department of Pediatric Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea.

出版信息

Front Pediatr. 2021 Feb 26;9:635394. doi: 10.3389/fped.2021.635394. eCollection 2021.

Abstract

Currently, indocyanine green (ICG) fluorescence imaging enables radical surgical resection in hepatoblastoma (HB) and has beneficial uses; however, its usage in pediatric patients is still limited. From 2015 to 2019, 17 hepatoblastoma patients underwent 22 fluorescence-guided surgery using ICG. ICG (0.3 mg/kg) was intravenously injected 24-48 h before the operation. With ICG/NIR camera, intraoperative identification of biological structures and demarcation of mass were conducted. ICG fluorescence-guided surgery was performed for hepatoblastoma in 22 cases: 16, 1, and 2 cases underwent anatomic resection, partial hepatectomy, and liver transplantation, respectively. Six patients accompanied lung metastasis at the time of surgery, and two patients underwent lung surgery using ICG. The median interval from ICG injection to surgery was 38.3 h (range, 20.5-50.3 h). The median tumor size was 36.5 mm (range, 2-132 mm). According to the pathologic finding, the median safety margin was secured for 6 mm (range, 0-11 mm) and there was no residual finding at the liver at the follow-up computed tomography (CT). ICG fluorescence imaging in children with HB was feasible and safe for tumor demarcation and enhancing the accuracy of radical tumor resection.

摘要

目前,吲哚菁绿(ICG)荧光成像能够实现肝母细胞瘤(HB)的根治性手术切除且具有有益用途;然而,其在儿科患者中的应用仍然有限。2015年至2019年,17例肝母细胞瘤患者接受了22次使用ICG的荧光引导手术。术前24 - 48小时静脉注射ICG(0.3mg/kg)。使用ICG/近红外相机进行术中生物结构识别和肿块划定。对22例肝母细胞瘤患者进行了ICG荧光引导手术:分别有16例、1例和2例接受了解剖性切除、肝部分切除术和肝移植。6例患者在手术时伴有肺转移,2例患者使用ICG进行了肺部手术。从ICG注射到手术的中位间隔时间为38.3小时(范围20.5 - 50.3小时)。肿瘤中位大小为36.5毫米(范围2 - 132毫米)。根据病理结果,中位安全切缘为6毫米(范围0 - 11毫米),随访计算机断层扫描(CT)时肝脏无残留发现。ICG荧光成像在儿童HB患者中对于肿瘤划定以及提高根治性肿瘤切除的准确性是可行且安全的。

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