Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Key Laboratory of Hepato-Biliary-Pancreatic Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China.
Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Surgery. 2022 Jun;171(6):1589-1595. doi: 10.1016/j.surg.2021.09.032. Epub 2021 Nov 29.
Intrahepatic cholangiocarcinoma is a highly lethal malignancy characterized by lymph node metastasis. This study aimed to evaluate the efficacy of indocyanine green fluorescence for visualization of lymphatic drainage and to assess its clinical application during laparoscopic lymph node dissection for intrahepatic cholangiocarcinoma.
All patients with intrahepatic cholangiocarcinoma who underwent laparoscopic left hepatectomy and lymph node dissection between October 2018 and January 2021 were reviewed. The patients were assigned to the indocyanine green group or non-intrahepatic cholangiocarcinoma group based on the staining technique used.
Of 38 patients with left hemiliver intrahepatic cholangiocarcinoma, 20 underwent intrahepatic cholangiocarcinoma tracer-guided laparoscopic radical left hepatectomy; 12 procedures were successful (indocyanine green group). During the same period, 18 patients were treated with traditional laparoscopic resection (control group). Their intraoperative factors were comparable and there were no differences in the incidence or severity of their postoperative complications 30 days after surgery (P > .05). In the indocyanine green group, more lymph nodes were harvested (mean [range]: 7.0 [6.0-8.0] vs 3.5 [3.0-5.0], P < .001) and the proportion of confirmed pathologic lymph nodes was higher (75.0%, 66.7%-87.5% vs 40%, 33.3%-50.0%, P < .001). ICG staining was observed in all (12/12, 100%) patients in the intrahepatic cholangiocarcinoma group at stations 8 and 12, and 9 (9/12, 75%) and 10 (11/12, 91.7%) patients at Stations 13 and 7, respectively.
The indocyanine green fluorescence imaging system is feasible, safe, and effective for tracing lymph nodes. It can be used to identify regional lymphatic drainage patterns and help define the scope of lymph node dissection in patients with intrahepatic cholangiocarcinoma.
肝内胆管癌是一种具有高度致死性的恶性肿瘤，其特征为淋巴结转移。本研究旨在评估吲哚菁绿荧光用于淋巴管可视化的效果，并评估其在腹腔镜肝内胆管癌淋巴结清扫术中的临床应用。
回顾性分析 2018 年 10 月至 2021 年 1 月期间行腹腔镜左半肝切除术和淋巴结清扫术的肝内胆管癌患者。根据染色技术将患者分为吲哚菁绿组或非肝内胆管癌组。
38 例左半肝肝内胆管癌患者中，20 例行肝内胆管癌示踪剂引导的腹腔镜根治性左半肝切除术；12 例手术成功（吲哚菁绿组）。同期，18 例行传统腹腔镜切除术（对照组）。两组术中因素具有可比性，术后 30 天并发症的发生率和严重程度无差异（P＞0.05）。在吲哚菁绿组中，更多的淋巴结被采集（平均[范围]：7.0[6.0-8.0] vs 3.5[3.0-5.0]，P＜0.001），且确认为病理淋巴结的比例更高（75.0%，66.7%-87.5% vs 40%，33.3%-50.0%，P＜0.001）。肝内胆管癌组 12 例患者的 8 区和 12 区、9 例患者的 13 区和 11 例患者的 7 区均观察到 ICG 染色（12/12，100%）。
吲哚菁绿荧光成像系统是一种可行、安全且有效的淋巴结示踪方法。它可用于识别区域性淋巴引流模式，并有助于确定肝内胆管癌患者的淋巴结清扫范围。
