三维CT重建联合吲哚菁绿荧光导航在胸腔镜解剖性肺段切除术中的应用

Application of 3D-CT Reconstruction Combined with Indocyanine Green Fluorescence in Anatomical Thoracoscopic Segmentectomy

目的探讨三维CT(3D-CT)重建联合吲哚菁绿荧光导航(ICGF)在胸腔镜解剖性肺段切除术中应用的可行性和疗效。方法前瞻性选取2017年1—12月在蚌埠医学院第一附属医院胸外科进行胸腔镜解剖性肺段切除术的患者20例为研究对象,其中18例为原发性肺癌、2例为转移性肺部肿瘤。术前评估目标段肺动脉,并利用3D-CT重建虚拟的段间平面。术中当目标段肺动脉和支气管被分开后,通过静脉注射吲哚菁绿(ICG,0.25 mg/kg),采用ICGF观察非靶区(NTS),并用电钩烧灼术标记目标和NTS之间的边界。记录患者基本信息,观察荧光首次出现时间、荧光持续时间、有效对比的持续时间及其他手术指标。结果 ICGF可以提供一个清晰的段间线,其荧光持续时间足够完成标记,成功对20例患者进行了肺表面的标记,并实施了胸腔镜解剖性肺段切除术。手术时间为(186.0±41.5)min,术中出血量为(30.0±17.8)ml。在注射ICG后,荧光首次出现时间为(20.0±10.5)s,荧光持续时间为(180.0±30.8)s,有效对比的持续时间为(70.0±11.6)s,足够临床医生标记分界线,该标记方法没有使患者出现并发症。结论 3D-CT重建联合ICGF可以充分地进行术前评估及清晰地显示段间线,为胸腔镜解剖性肺段切除术提供可靠的技术保障,是一种安全有效的方法,值得在临床推广应用。

Objective To investigate the feasibility and efficacy of three-dimensional CT(3D-CT)reconstruction combined with indocyanine green fluorescence(ICGF)in anatomical thoracoscopic segmentectomy.Methods Twenty patients who underwent anatomical thoracoscopic segmentectomy in the Department of Thoracic Surgery,the First Affiliated Hospital of Bengbu Medical College between January and December 2017 were selected as study subjects,including 18 cases of primary lung cancer and 2 cases of metastatic lung cancer.The target segment of the pulmonary artery was evaluated preoperatively,and the virtual segment plane was reconstructed with 3D-CT.During the operation,when the target segment pulmonary artery and bronchus were separated,ICG(0.25 mg/kg)was intravenously injected.ICGF in the non-target segments(NTS)was observed,and the boundaries between target segments and NTS were marked with an electrical burn.Patient's baseline characteristics,and the time of first appearance of fluorescence,the duration of ICGF and the duration of effective contrast and other surgical indicators were observed and recorded.Results ICGF provided a clear mark delineating segments,and its fluorescence duration was sufficient to complete the labeling.Lung surface labeling and anatomical thoracoscopic segmentectomy were successfully completed in all 20 patients.The operation time was(186.0±41.5)min,and the blood loss was(30.0±17.8)ml.After the injection of ICG,the time of first appearance of fluorescence was(20.0±10.5)s,and the duration of fluorescence was(180.0±30.8)s;the duration of effective contrast was(70.0±11.6)s,which was sufficient for clinicians to perform labeling.The methods did not cause side effects in the patients.Conclusion 3D-CT reconstruction combined with ICGF allows for full preoperative evaluation and clearly shows the segmental boundary,thus providing a reliable technique for anatomical thoracoscopic segmentectomy.It is a safe and effective method worthy of further clinical use.