From the Department of Hepatobiliary Surgery and Institute of Digital Intelligence, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
Guangdong Digital Medical Clinical Engineering and Technology Research Center, Guangzhou, China.
J Am Coll Surg. 2024 Mar 1;238(3):321-330. doi: 10.1097/XCS.0000000000000912. Epub 2023 Nov 22.
The internal anatomy of the liver is extremely complex. Laparoscopic anatomical segmentectomy requires reference to the position and alignment of intrahepatic vascular. However, the surface of the liver lacks anatomical landmarks and the liver segment boundaries cannot be identified with the naked eye. Augmented reality navigation (ARN) and indocyanine green fluorescence imaging (FI) are emerging navigation tools in liver resection. This study aimed to explore the efficacy and application value of laparoscopic anatomical segmentectomy guided by ARN combined with indocyanine green FI.
Ninety-eight patients who were diagnosed with hepatocellular carcinoma and underwent laparoscopic anatomical segmentectomy from January 2018 to January 2022 were retrospectively analyzed. They were divided into the ARN-FI group (45 patients) and the non-ARN-FI group (53 patients) based on whether ARN combined with FI was applied during the operation. The differences in intraoperative and postoperative outcomes were compared.
There was no significant difference in preoperative baseline data and postoperative complication rates between the 2 groups. Compared with the non-ARN-FI group, the ARN-FI group had much lower intraoperative blood loss (100 vs 200 mL, p = 0.005) and a lower incidence of remnant liver ischemia (13.3% vs 30.2%, p = 0.046). The 1- and 3-year disease-free survival rates in the ARN-FI and non-ARN-FI groups were 91.01% vs 71.15% and 70.01% vs 52.46%, respectively; the differences between the 2 groups were statistically significant (p = 0.047).
The ARN-FI technology provides a more standardized approach for liver parenchyma section during laparoscopic liver resection, effectively minimizing intraoperative blood loss, reducing postoperative remnant liver ischemia, and improving oncological prognosis. This method is safe and feasible and has good clinical application prospects.
肝脏的内部解剖结构极其复杂。腹腔镜解剖性肝段切除术需要参考肝内血管的位置和走向。然而，肝脏表面缺乏解剖学标志，肉眼无法识别肝段边界。增强现实导航（ARN）和吲哚菁绿荧光成像（FI）是肝切除术中新兴的导航工具。本研究旨在探讨 ARN 联合吲哚菁绿 FI 引导腹腔镜解剖性肝段切除术的疗效及应用价值。
回顾性分析 2018 年 1 月至 2022 年 1 月诊断为肝细胞癌并接受腹腔镜解剖性肝段切除术的 98 例患者。根据术中是否应用 ARN 联合 FI 将其分为 ARN-FI 组（45 例）和非-ARN-FI 组（53 例）。比较两组患者术中及术后结局的差异。
两组患者术前基线资料及术后并发症发生率差异无统计学意义。与非-ARN-FI 组相比，ARN-FI 组术中出血量更少（100 比 200ml，p=0.005），残肝缺血发生率更低（13.3%比 30.2%，p=0.046）。ARN-FI 组和非-ARN-FI 组的 1 年和 3 年无疾病生存率分别为 91.01%比 71.15%和 70.01%比 52.46%，两组间差异有统计学意义（p=0.047）。
ARN-FI 技术为腹腔镜肝切除术中肝实质分段提供了一种更标准化的方法，有效减少了术中出血量，降低了术后残肝缺血的发生率，改善了肿瘤学预后。该方法安全可行，具有良好的临床应用前景。
