摘要
目的探讨ICG荧光导航技术在困难腹腔镜肝切除中应用的安全性和疗效。方法回顾性分析2019年1月至2022年4月在中国科学技术大学附属第一医院行困难腹腔镜肝切除的51例患者临床资料。其中男38例,女13例;年龄16~77岁,中位年龄57岁。患者均签署知情同意书,符合医学伦理学规定。其中肝细胞癌41例,胆管细胞癌3例,混合性肝癌3例,局灶性增生3例,血管瘤1例。根据术中有无使用ICG荧光导航技术,将患者分为ICG组(25例)和常规组(26例)。观察两组围手术期情况及术后并发症发生情况。结果ICG组平均手术时间为(311±88)min,明显短于对照组的(385±118)min(t=-2.538,P<0.05)。两组手术方式、术中出血量、术中输血、肝门阻断时间、术后住院时间、中转开腹率、90 d再手术率及90 d再住院率差异无统计学意义(P>0.05)。两组术后90 d内均未发生围手术期死亡,未发生Clavien-Dindo分级Ⅲa级以上严重并发症。ICG组术后总并发症发生率为16%(4/25),明显低于对照组的42%(11/26)(χ^(2)=4.249,P<0.05)。结论ICG荧光导航技术可明显降低困难腹腔镜肝切除的手术时间和术后并发症发生率,有望为高难度和高风险患者提供更安全、便捷的手术方式选择。
Objective To evaluate the safety and efficacy of indocyanine green(ICG)fluorescence navigation in difficult laparoscopic hepatectomy.Methods Clinical data of 51 patients who underwent difficult laparoscopic hepatectomy in the First Affiliated Hospital of University of Science and Technology of China from January,2019 to April,2022 were retrospectively analyzed.Among them,38 patients were male and 13 female,aged from 16 to 77 years,with a median age of 57 years.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,41 patients were diagnosed with hepatocellular carcinoma,3 cases of cholangiocarcinoma,3 cases of mixed liver cancer,3 casesof focal hyperplasia and 1 case of hemangioma,respectively.All patients were divided into the ICG group(n=25)and control group(n=26)according to whether ICG fluorescence navigation was employed intraoperatively.Perioperative conditions and postoperative complications were observed between two groups.Results In the ICG group,the average operation time was(311±88)min,significantly shorter than(385±118)min in the control group(t=-2.538,P<0.05).No significant differences were noted in surgical method,intraoperative blood loss,intraoperative blood transfusion,hepatic portal occlusion time,length of postoperative hospital stay,rate of conversion to open surgery,90-d reoperation rate and 90-d readmission rate between two groups(all P>0.05).No perioperative death within postoperative 90 d occurred intwo groups.No severe complications≥Clavien-Dindo gradeⅢa were reported.In the ICG group,the incidence of postoperative complications was 16%(4/25),significantly lower than 42%(11/26)in the control group(χ^(2)=4.249,P<0.05).Conclusions ICG fluorescence navigation can significantly shorten the operation time and lower the incidence of postoperative complications in difficult laparoscopic hepatectomy,which is expected to provide a safer and simpler surgical option for patients requiring challenging and high-risk laparoscopic hepa
作者
周毅
王一帆
张传海
马金良
余继海
荚卫东
Zhou Yi;Wang Yifan;Zhang Chuanhai;Ma Jinliang;Yu Jihai;Jia Weidong(Department of Hepatobiliary Surgery,Anhui Provincial Hospital affiliated to Anhui Medical University,Hefei 230036,China;Department of Liver Surgery,the First Affiliated Hospital of University of Science and Technology of China,Hefei 230036,China)
出处
《中华肝脏外科手术学电子杂志》
CAS
2023年第4期407-411,共5页
Chinese Journal of Hepatic Surgery(Electronic Edition)
基金
2021年安徽省重点研究与开发计划项目(202104j07020048)。
关键词
腹腔镜
肝切除术
吲哚氰绿
荧光显像
术中超声
Laparoscopes
Hepatectomy
Indocyanine green
Fluorescence imaging
Intraoperative ultrasonography(IOUS)
