摘要
目的探讨吲哚氰绿(ICG)荧光显像导航技术在复发性肝癌腹腔镜再次肝切除中的应用价值。方法回顾性分析2018年1月至2019年4月在四川大学华西医院行腹腔镜再次肝切除的10例复发性肝癌患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男9例,女1例;年龄48~83岁,中位年龄62岁。所有患者术前肝功能Child-Pugh分级均为A级。采用ICG荧光显像导航技术行腹腔镜再次肝切除术,术前3~14 d通过外周静脉注射ICG(0.5 mg/kg),术中通过ICG荧光显像确定肿瘤位置后,距离肿瘤边缘1~2 cm处离断肝实质。结果所有患者均成功完成腹腔镜肝切除术,无中转开腹,肿瘤均达到根治性切除。其中行右半肝切除术1例,左半肝切除术1例,肝中叶切除术1例,左外叶切除术2例,左肝外叶+右肝局部切除术1例,肝局部切除术4例。无发生围手术期死亡。术中出血量中位数为75(20~500)ml,仅1例患者术中输血,1例术后出现肺部感染,无胆漏、肝衰竭等并发症。术后住院时间5(2~11)d,均顺利出院。术后随访时间为1~14个月,中位随访时间9个月。随访期内均存活,1例患者术后9个月肿瘤再次复发,其余未见复发及转移。结论在复发性肝癌腹腔镜再次肝切除中采用ICG荧光显像导航技术,具有微创化、可视化、精准化的优势,是安全、有效的。
Objective To explore the application value of indocyanine green(ICG)fluorescence imaging navigation in repeat laparoscopic hepatectomy for recurrent liver cancer.Methods Clinical data of 10 patients with recurrent liver cancer who underwent repeat laparoscopic hepatectomy in West China Hospital from January 2018 to April 2019 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,9 patients were male and 1 female,aged 48-83 years old with a median age of 62 years old.Before operation,all patients were with Child-Pugh grade A liver function.Laparoscopic hepatectomy was performed with ICG fluorescence imaging navigation.ICG(0.5 mg/kg)was injected in the peripheral vein at preoperative 3-14 d.Intraoperatively,ICG fluorescence imaging was utilized to determine the tumor location.The liver parenchyma was resected at 1-2 cm from the tumor margin.Results All patients underwent laparoscopic hepatectomy successfully without conversion to open surgery.All tumors were radically resected.Among them,1 case underwent right hepatectomy,1 case of left hepatectomy,1 case of mesohepatectomy,2 cases of left lateral hepatectomy,1 case of left lateral hepatectomy+partial hepatectomy of the right lobe and 4 cases of partial hepatectomy,respectively.No perioperative death occurred.The median intraoperative blood loss was 75(20-500)ml.Only one patient received intraoperative blood transfusion.One patient developed pulmonary infection after operation.No postoperative complications,such as bile leakage and liver failure,were observed.The length of postoperative hospital stay was 5(2-11)d.All patients were discharged.Postoperative follow-up time was 1-14 months with a median follow-up time of 9 months.All patients survived during the postoperative follow-up.One patient recurred at 9 months after surgery.No recurrence or metastasis was noted in the remaining cases.Conclusions ICG fluorescence imaging navigation is safe and effective when applied in repeat laparoscopic hepatectomy for recurrent liver cancer,which has multiple advantages regarding minimal invasiveness,visualization and precision.
作者
谢国伟
李嘉鑫
吴泓
Xie Guowei;Li Jiaxin;Wu Hong(Department of Hepatobiliopancreatic Surgery,West China Hospital of Sichuan University,Chengdu 610041,China)
出处
《中华肝脏外科手术学电子杂志》
CAS
2020年第2期153-157,共5页
Chinese Journal of Hepatic Surgery(Electronic Edition)
基金
四川省科技厅项目(2017KZ0019)。
关键词
癌
肝细胞
复发
腹腔镜
肝切除术
吲哚花青绿
Carcinoma,hepatocellular
Recurrence
Laparoscopes
Hepatectomy
Indocyanine green
