吲哚菁绿荧光融合影像引导在腹腔镜解剖性肝切除术中的应用价值

Application value of fusion indocyanine green fluorescence imaging in the laparoscopic anatomical liver resection

    摘要
  • 摘要: 目的:探讨吲哚菁绿荧光融合影像(FIGFI)引导在腹腔镜解剖性肝切除术中的应用价值。
    方法:采用回顾性横断面研究方法。收集2015年12月至2017年2月解放军总医院收治的21例采用FIGFI引导下完成的腹腔镜解剖性肝切除术患者的临床资料。吲哚菁绿(ICG) 荧光染色采用正染法或反染法。观察指标：(1)术中情况：手术方式，肝切除范围及相应ICG荧光染色方式和结果，手术时间，术中出血量，术中输血例数。(2)术后情况：术后并发症，术后住院时间，术后病理学检查。(3)随访情况。采用门诊和电话方式进行随访，了解患者术后生存及肿瘤复发、转移情况。随访时间截至2017年3月。正态分布的计量资料以平均数(范围)表示。
    结果:(1)术中情况：21例患者中，20例采用FIGFI引导下成功完成腹腔镜解剖性肝切除术，1例中转开腹。21例患者中，5例ICG荧光染色采用正染法，16例采用反染法；17例染色成功，4例染色失败。21例患者平均手术时间为268 min(120～360 min)，平均术中出血量为388 mL(100～800 mL)，术中输血例数为3例。(2)术后情况：5例患者术后发生并发症，其中Clavien系统分级 Ⅰ级3例，Ⅱ级2例。21例患者平均术后住院时间为9.3 d(6.0～14.0 d)。16例恶性肿瘤患者切缘均为阴性。(3)随访情况：21例患者均获得术后随访。随访时间为1.0～14.0个月，中位随访时间为3.3个月。随访期间，患者均生存，1例患者肿瘤复发。
    结论:FIGFI引导腹腔镜解剖性肝切除术安全可行，近期疗效较好。

     

    Abstract: Objective:To investigate the application value of fusion indocyanine green fluorescence imaging (FIGFI) in the laparoscopic anatomical liver resection (ALR).
    Methods:The retrospective crosssectional study was conducted. The clinical data of 21 patients who underwent laparoscopic ALR using FIGFI in the Chinese People′s Liberation Army General Hospital between December 2015 and February 2017 were collected. Indocyanine green (ICG) staining included positive staining and negative staining. Observation indicators: (1) intraoperative situations: surgical procedures, extent of liver resection, methods and results of ICG staining, operation time, volume of intraoperative blood loss, cases with blood transfusion; (2) postoperative situations: postoperative complications, duration of postoperative hospital stay, postoperative pathological examination; (3) followup situations. Followup using outpatient examination and telephone interview was performed to detect the patients′ survival and tumor recurrence or metastasis up to March 2017. Measurement data with normal distribution were represented as average (range).
    Results:(1) Intraoperative situations: of 21 patients, 20 underwent successful laparoscopic ALR and 1 had conversion to open surgery. The positive and negative stainings of ICG were respectively applied to 5 and 16 patients. Seventeen patients had successful staining and 4 had failed staining. Average operation time, average volume of intraoperative blood loss and cases with blood transfusion were respectively 268 minutes (range, 120-360 minutes), 388 mL (range, 100-800 mL) and 3. (2) Postoperative situations: 5 patients had postoperative complications, including 3 with ClavienDindo classification I and 2 with ClavienDindo classification II. Average duration of postoperative hospital stay of 21 patients was 9.3 days (range, 6.0-14.0 days). Sixteen patients with malignant tumor had negative surgical margins. (3) Followup situations: all the 21 patients were followed up for 1.0-14.0 months, with a median time of 3.3 months. During followup, all the patients survived, and 1 patient had tumor recurrence.
    Conclusion:The FIGFI is safe and feasible in the laparoscopic ALR, with a good short-term outcome.

     

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