增强现实导航技术联合吲哚菁绿分子荧光影像在肝门部胆管癌根治术中应用研究

Application of augmented reality navigation technology combined with indocyanine green fluorescent imaging in radical surgery for hilar cholangiocarcinoma

目的探讨增强现实导航技术联合吲哚菁绿(ICG)分子荧光影像在肝门部胆管根治性手术的可行性、安全性及近期效果。方法回顾性分析南方医科大学珠江医院肝胆外科2019年4月至2020年8月期间完成的3例增强现实联合ICG分子荧光影像导航肝门部胆管癌根治术病人的临床资料,收集病人薄层CT数据,构建三维模型后制定个体化手术方案。术前24~72 h根据肝功能情况经外周静脉注射ICG,术中利用腹腔镜增强现实手术导航系统,采集实时手术影像,再通过视频采集卡输入笔记本电脑,在增强现实手术导航系统中实现将三维模型投影到手术视频,实现术中情况与术前三维模型实时融合导航,指导手术治疗。结果3例病人构建三维可视化模型后,均成功行增强现实导航技术联合ICG分子荧光影像技术指导下肝门部胆管癌根治术。BismuthCorlette三维可视化分型Ⅲb型2例、Ⅳa型1例,1例罕见的门静脉右前支缺如变异。Ⅲb型2例行左半肝切除联合左侧尾状叶切除术、Ⅳa型1例行右半肝联合全尾状叶切除术。手术时间分别为420、410、380 min,术中出血量分别为360、310、250 mL,术后住院时间分别为9、8、8 d。术后出现少量胸腔积液1例,经内科治疗后康复出院,围手术期无肝功能衰竭及死亡病例。结论增强现实导航技术联合ICG分子荧光影像在肝门部胆管根治性术中应用效果良好、安全可行、值得进一步探索。

Objective To investigate the feasibility,safety and short-term effects of augmented reality navigation technology combined with indocyanine green(ICG)fluorescent imaging in radical surgery for hilar cholangiocarcinoma.Methods The clinical data of 3 patients undergoing radical surgery for hilar cholangiocarcinoma using augmented reality combined with ICG fluorescent imaging performed between April 2019 and August 2020 in the Department of Hepatobiliary Surgery,Zhujiang Hospital of Southern Medical University were analyzed retrospectively.Thin-slice CT data of patients were collected and reconstructed into 3D image for individualized surgical planning.ICG was injected intravenously 24 to 72 hours prior to surgery according to the liver function.During the operation,the laparoscopic augmented reality surgical navigation system developed by the author’s team was used to collect real-time surgical images,and then the images were input into a laptop computer through the video capture card.Through the navigationsystem,the 3D reconstructed images were projected onto the surgical video,thus achieving real-time fusion navigation of intraoperative situation and preoperative 3D images to guide surgical treatment.Results After 3D modelling,radical resection for hilar cholangiocarcinoma was successfully performed in the 3 patients under the guidance of augmented reality navigation technology combined with ICG fluorescentimaging.Three patients were classified by Bismuth-Corlette 3D visualization type:2 cases with typeⅢb and 1 case with typeⅣa,and 1 case with a rare absence of the right anterior branch of the portal vein.Two cases of typeⅢb underwent left hepatectomy combined with left caudate lobectomy,and one case of type VIa underwent right hemihepatectomy combined with total caudate lobectomy.The operation time was 420 min,410 min,380 min;the intraoperative blood loss was 360 m L,310 m L,250 m L;and the average postoperative hospital stay was 9 days,8 days,8 days.One case had a small amount of pleural effusion after operation,and was discharged after medical treatment.There were no liver failure or deaths during the perioperative period.Conclusion The preliminary results of the study show that augmented reality navigation technology combined with ICG fluorescent imaging is effective,safe and feasible in radical surgery for hilar cholangiocarcinoma,and is worthy of further exploration.