Chen Zhen-Rong, Zeng Qing-Teng, Shi Ning, Han Hong-Wei, Chen Zhi-Hong, Zou Yi-Ping, Zhang Yuan-Peng, Wu Fan, Xu Lian-Qun, Jin Hao-Sheng
Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong Province, China.
Department of General Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510000, Guangdong Province, China.
World J Gastrointest Surg. 2023 Jul 27;15(7):1442-1453. doi: 10.4240/wjgs.v15.i7.1442.
Indocyanine green (ICG) fluorescence played an important role in tumor localization and margin delineation in hepatobiliary surgery. However, the preoperative regimen of ICG administration was still controversial. Factors associated with tumor fluorescence staining effect were unclear.
To investigate the preoperative laboratory indexes corelated with ICG fluorescence staining effect and establish a novel laboratory scoring system to screen specifical patients who need ICG dose adjustment.
To investigate the predictive indicators of ICG fluorescence characteristics in patients undergoing laparoscopic hepatectomy from January 2018 to January 2021 were included. Blood laboratory tests were completed within 1 wk before surgery. All patients received 5 mg ICG injection 24 h before surgery for preliminary tumor imaging. ImageJ software was used to measure the fluorescence intensity values of regions of interest. Correlation analysis was used to identify risk factors. A laboratory risk model was established to identify individuals at high risk for high liver background fluorescence.
There were 110 patients who were enrolled in this study from January 2019 to January 2021. The mean values of fluorescence intensity of liver background (FI-LB), fluorescence intensity of gallbladder, and fluorescence intensity of target area were 18.87 ± 17.06, 54.84 ± 33.29, and 68.56 ± 36.11, respectively. The receiver operating characteristic (ROC) curve showed that FI-LB was a good indicator for liver clearance ability [area under the ROC curve (AUC) = 0.984]. Correlation analysis found pre-operative aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transpeptidase, adenosine deaminase, and lactate dehydrogenase were positively associated with FI-LB and red blood cell, cholinesterase, and were negatively associated with FI-LB. Total laboratory risk score (TLRS) was calculated according to ROC curve (AUC = 0.848, sensitivity = 0.773, specificity = 0.885). When TLRS was greater than 6.5, the liver clearance ability of ICG was considered as poor.
Preoperative laboratory blood indicators can predict hepatic ICG clearance ability. Surgeons can adjust the dose and timing of ICG preoperatively to achieve better liver fluorescent staining.
吲哚菁绿（ICG）荧光在肝胆外科手术中对肿瘤定位和边界勾勒起着重要作用。然而，ICG给药的术前方案仍存在争议。与肿瘤荧光染色效果相关的因素尚不清楚。
探讨与ICG荧光染色效果相关的术前实验室指标，并建立一种新的实验室评分系统，以筛选需要调整ICG剂量的特定患者。
纳入2018年1月至2021年1月行腹腔镜肝切除术患者，以研究ICG荧光特征的预测指标。术前1周内完成血液实验室检查。所有患者在术前24小时接受5mg ICG注射以进行初步肿瘤成像。使用ImageJ软件测量感兴趣区域的荧光强度值。采用相关性分析确定危险因素。建立实验室风险模型以识别肝背景荧光高风险个体。
2019年1月至2021年1月共有110例患者纳入本研究。肝脏背景荧光强度（FI-LB）、胆囊荧光强度和靶区荧光强度的平均值分别为18.87±17.06、54.84±33.29和68.56±36.11。受试者工作特征（ROC）曲线显示，FI-LB是肝脏清除能力的良好指标[ROC曲线下面积（AUC）=0.984]。相关性分析发现，术前天冬氨酸转氨酶、丙氨酸转氨酶、γ-谷氨酰转肽酶、腺苷脱氨酶和乳酸脱氢酶与FI-LB呈正相关，红细胞、胆碱酯酶与FI-LB呈负相关。根据ROC曲线计算总实验室风险评分（TLRS）（AUC=0.848，敏感性=0.773，特异性=0.885）。当TLRS大于6.5时，认为ICG的肝脏清除能力较差。
术前实验室血液指标可预测肝脏ICG清除能力。外科医生可在术前调整ICG的剂量和时间，以获得更好的肝脏荧光染色效果。
