摘要
目的探讨腹腔镜下吲哚菁绿(indocyanine green,ICG)双荧光染色肝Ⅳb段切除治疗肝细胞癌的临床应用价值。方法收集2016年11月至2020年1月解放军总医院第一医学中心肝胆外科收治的10例肝细胞癌病人的临床资料,所有病人术前5~7 d均常规行ICG清除试验,采用ICG双荧光染色行腹腔镜下肝Ⅳb段切除。观察指标:①术中情况:肿瘤荧光显像情况、术中肝段ICG荧光染色方式及效果、手术时间、出血量、输血例数、中转开腹例数。②术后情况:术后并发症情况(以Clavien-Dindo分级为标准)、术后住院时间、术后病理学检查结果以及随访情况。结果①术中情况:10例病人中8例可见术中肿瘤荧光显像;肝Ⅳb段ICG荧光染色方式:1例采用正染,9例采用反染,全部病例初始肝脏表面荧光界限清晰,肝实质离断中6例仍能保持肝内段间荧光界面。全腹腔镜下完成10例手术,无术中输血及中转开腹病例,平均手术时间为130 min(95~190 min),平均出血量为120 ml(30~450 ml)。②术后情况:4例发生Clavien-DindoⅠ~Ⅱ级并发症,均经治疗后好转,无Ⅲ级以上严重并发症,无围手术期死亡;术后平均住院时间为6.4 d(4~12 d);10例术后病理结果均为肝细胞性肝癌,切缘均阴性。失访1例,其余9例病人均存活至今,其中2例术后复发接受腹腔镜超声引导的肝脏肿瘤射频消融治疗。结论腹腔镜下ICG双荧光染色解剖性肝Ⅳb段切除治疗肝癌安全可行,ICG荧光肝段染色方式推荐反染法。
Objective To investigate the application value of indocyanine green(ICG)dual fluorescence imaging in laparoscopic anatomical hepatectomy of subsegmentⅣb for hepatocellular carcinoma.Methods The clinical data of 10 patients with hepatocellular carcinoma admitted to the Department of Hepatobiliary Surgery of the First Medical Center of Chinese PLA General Hospital from November 2016 to January 2020 were collected.All patients routinely underwent ICG clearance test 5 to 7 days before operation,and laparoscopic hepatectomy of segmentⅣb was performed using ICG double fluorescence staining.Outcome measures:①Intraoperative conditions:tumor fluorescence imaging,intraoperative liver segment ICG fluorescence staining method and effect,operation time,blood loss,number of blood transfusions,number of cases of conversion to laparotomy.②Postoperative conditions:postoperative complications(Clavien-Dindo grade was used as the standard),postoperative hospital stay,postoperative pathological examination results and follow-up.Results①Intraoperative conditions:Intraoperative tumor fluorescence imaging was observed in 8 of 10 patients;ICG fluorescence staining methods of liver segmentⅣb:1 case was positively stained and 9 cases were counterstained.The initial liver surface fluorescence boundary was clear in all cases,and the intersegmental fluorescence interface could still be maintained in 6 cases of liver parenchymal transection.Totally laparoscopic surgery was completed in 10 cases,and there was no intraoperative blood transfusion or conversion to laparotomy.The average operation time was 130 min(95-190 min),and the average blood loss was 120 ml(30-450 ml).②Postoperative conditions:4 cases had Clavien-Dindo gradeⅠ-Ⅱcomplications and were improved after treatment,without severe complications above gradeⅢ,without perioperative death;the average postoperative hospital stay was 6.4 d(4-12 d);10 cases had postoperative pathological results of hepatocellular carcinoma,with negative resection margin.One patient was lo
作者
叶钢
张涛
王勋
陈明易
王宏光
Ye Gang;Zhang Tao;Wang Xun;Chen Mingyi;Wang Hongguang(Department of Hepatobiliary Surgery,People's Hospital of Changshou Chongqing,Chongqing 401220,China;Department of Hepatobiliary Surgery, The First Medical Center of Chinese PLA General Hospital,Beijing 100853, China)
出处
《腹部外科》
2020年第3期180-183,189,共5页
Journal of Abdominal Surgery
关键词
肝切除术
腹腔镜
荧光成像
吲哚菁绿
肝细胞癌
Hepatectomy
Laparoscopic
Fluorescence imaging
Indocyanine green
Hepatocellular carcinoma
