Hou Z Q, Xie Q Y, Liao M H, Liu C, Qiu G T, Jin Z X, Mi S Z, Huang J W
Department of Liver Surgery and Liver Transplantation Center,West China Hospital,Sichuan University,Chengdu 610041,China.
Zhonghua Wai Ke Za Zhi. 2023 Mar 29;61(5):368-374. doi: 10.3760/cma.j.cn112139-20230113-00021.
To examine the clinical value of fluorescence-guided indocyanine green (ICG) laparoscopic anatomical hepatectomy in the treatment of primary hepatocellular carcinoma. Data from patients diagnosed with hepatocellular carcinoma and who underwent laparoscopic hepatectomy with ICG fluorescence navigation in the Department of Liver Surgery and Liver Transplantation Center of West China Hospital between September 2020 and May 2022 were retrospectively collected. There were 53 males and 19 females, with an age of (55.5±12.9)years(range:42.6 to 68.4 years). Among them, 13 of the cases underwent laparoscopic anatomical liver resection(LALR) guided by tans-arterial ICG,43 of the cases received LAIR guided by portal vein negative ICG, and 16 of the cases received LALR positive by portal vein. Comparison among the three groups was performed by one-way ANOVA; and the rank sum test was used for comparison between groups. The counting data was expressed as percentage,and the test or Fisher's exact probability method was used for comparison between groups. (1) Postoperative pathology: Resection R0 was achieved in all operations. The maximum tumor diameter of the patients in the arterial staining group, the reverse staining group, and the positive staining group( (IQR)) was 2.5 (2.4) cm, 3.0 (2.5) cm and 3.0(2.4) cm,respectively. There were no statistically significant differences in the maximum tumor diameter between the three groups (=0.364). The minimum tumor margin was 1.1 (1.1) cm, 1.0 (1.0) cm, 1.1 (1.6) cm in the the arterial staining group, reverse staining group and the positive staining group, respectively. There was no significant difference in the margin among the three groups (=0.878). (2) Operation conditions: the operation time of the arterial staining group, the negative staining group, and the positive portal staining group was (348±93)minutes,(277±112)minutes,and (295±116)minutes,respectively. There were no significant differences in operation time among the three groups (=0.134). The intraoperative blood loss of the three groups was 80(150)ml,200(350)ml,and 100(150)ml,respectively. There was no statistically significant difference in intraoperative bleeding volume between the three groups(=0.743). All cases were not transfused during the operation and were not converted to laparotomy. ALT in the arterial staining group was higher than in the negative staining group in the first two days after the operation ((559±398)IU/L307(257) IU/L, =235.5,=0.004;(611±389)IU/L(331±242) IU/L, =265.2, =0.002). There was only one case of a grade III complication (Clavien-Dindo grading system) postoperative complication in the negative and positive staining group of the portal vein, respectively. Tumor markers in all patients decreased to the normal range after 2 months of operation. Laparoscopic anatomical hepatectomy guided by ICG fluorescence through arterial staining and portal vein staining is safe and feasible for primary hepatocellular carcinoma treatment.
探讨荧光引导下吲哚菁绿（ICG）腹腔镜解剖性肝切除术治疗原发性肝细胞癌的临床价值。回顾性收集2020年9月至2022年5月在四川大学华西医院肝脏外科及肝移植中心诊断为肝细胞癌并接受ICG荧光导航腹腔镜肝切除术的患者资料。其中男性53例，女性19例，年龄（55.5±12.9）岁（范围：42.6至68.4岁）。其中，13例患者接受经动脉ICG引导的腹腔镜解剖性肝切除术（LALR），43例患者接受门静脉阴性ICG引导的LAIR，16例患者接受门静脉阳性LALR。三组间比较采用单因素方差分析；组间比较采用秩和检验。计数资料以百分比表示，组间比较采用检验或Fisher确切概率法。（1）术后病理：所有手术均实现R0切除。动脉染色组、反向染色组和阳性染色组患者的最大肿瘤直径（四分位间距）分别为2.5（2.4）cm、3.0（2.5）cm和3.0（2.4）cm。三组间最大肿瘤直径差异无统计学意义（=0.364）。动脉染色组、反向染色组和阳性染色组的最小肿瘤切缘分别为1.1（1.1）cm、1.0（1.0）cm、1.1（1.6）cm。三组间切缘差异无统计学意义（=0.878）。（2）手术情况：动脉染色组、阴性染色组和门静脉阳性染色组的手术时间分别为（348±93）分钟、（277±112）分钟和（295±116）分钟。三组间手术时间差异无统计学意义（=0.134）。三组术中出血量分别为80（150）ml、200（350）ml和100（150）ml。三组术中出血量差异无统计学意义（=0.743）。所有病例术中均未输血，未中转开腹。术后前两天动脉染色组ALT高于阴性染色组（（559±398）IU/L对307（257）IU/L，=235.5，=0.004；（611±389）IU/L对（331±242）IU/L，=265.2，=0.002）。门静脉阴性和阳性染色组术后并发症各有1例Ⅲ级并发症（Clavien-Dindo分级系统）。所有患者术后2个月肿瘤标志物均降至正常范围。ICG荧光通过动脉染色和门静脉染色引导的腹腔镜解剖性肝切除术治疗原发性肝细胞癌安全可行。
