吲哚菁绿荧光显影技术在机器人辅助腹腔镜上尿路重建手术中的应用

Applications of indocyanine green and near-infrared fluorescence imaging technology in robot-assisted laparoscopic upper urinary tract reconstruction

目的探讨吲哚菁绿荧光显影技术在机器人辅助腹腔镜上尿路重建手术中的应用价值。方法回顾性分析2022年11月至2023年1月北京市健宫医院收治的11例行机器人辅助腹腔镜上尿路重建手术患者的临床资料。其中肾盂成形术5例(含盆腔异位肾1例),口腔颊黏膜代输尿管术2例,肾盂瓣成形术、输尿管膀胱再植术、回肠代双侧输尿管术各1例,一侧肾盂成形+对侧口腔颊黏膜代输尿管术1例。术中通过肾造瘘管或输尿管导管注入吲哚菁绿、静脉注射吲哚菁绿,利用机器人系统的集成荧光显影技术对区域组织进行实时显影分析,辨别定位输尿管,明确组织血供情况。收集患者手术时间、术中出血量、术后恢复情况等资料进行分析。结果11例患者均顺利完成手术。手术时间120~435 min、中位时间205 min。术中出血量20~200 ml、中位出血量50 ml。术中运用荧光显影技术,输尿管均显影,区域吻合组织血供良好。所有患者均无Clavien-DindoⅡ级以上并发症出现。3例肾造瘘患者术后2个月行上尿路影像尿动力学检查后拔除肾造瘘管。8例患者术后3月复查显示患侧肾积水缓解、梗阻解除。结论吲哚菁绿荧光显影技术在机器人辅助腹腔镜上尿路重建手术中有助于辨别定位输尿管、明确组织血供情况和指导手术策略,对提高手术安全性和临床疗效有一定作用。

Objective To explore the feasibility and effect of indocyanine green(ICG)and near-infrared fluorescence imaging technology(NIRF)in robot-assisted laparoscopic upper urinary tract reconstruction.Methods The clinical data of 11 patients with robot-assisted laparoscopic upper urinary tract reconstruction from Beijing Jiangong Hospital between November 2022 and January 2023 were retrospectively analyzed.Among them,there were 5 cases of pyeloplasty(including 1 case of pelvic ectopic kidney),2 cases of buccal mucosa graft of ureter,1 case of pelvic flap pyeloplasty,1 case of ureteral bladder replantation,1 case of ileal replacement of bilateral ureter,and 1 case of unilateral pyeloplasty with buccal mucosa graft of opposite ureter.By intraoperative instillation of ICG through nephrostomy tube or ureteral catheter and intravenous injection of ICG,the integrated NIRF of the robot system was used to conduct real-time imaging analysis of regional tissues,identify and locate the ureter,and clarify the blood supply of the tissue.The data such as operation time,intraoperative blood loss,and postoperative recovery of patients were collected and analyzed.Results All the 11 operations were successful.Operation duration was 120-435 min(the median time was 205 min),and volume of blood loss was 20-200 ml(the median bleeding volume was 50ml).ICG-NIRF was used during operation,all ureters were visualized,and the blood supply of the regional anastomotic tissue was good.All patients had no Clavien-Dindo gradeⅡabove complications.Three patients with nephrostomy underwent urodynamic test of upper urinary tract imaging in 2 months after operation,and then the nephrostomy tube was removed.Eight patients underwent a 3-month follow-up examination and showed relief of hydronephrosis and ureteral obstruction on the affected side.Conclusion ICG-NIRF is helpful to identify the ureter,observe the tissue blood supply and guide the surgical strategy in robot-assisted laparoscopic upper urinary tract reconstruction,and has a certain role in improving the surgical safety and clinical efficacy.