吲哚菁绿标记近红外荧光腹腔镜胃癌根治术的应用价值评估

Clinical application near-infrared camera imaging with indocyanine green-enhanced fluorescence technique in laparoscopic radical gastrectomy

目的:研究吲哚菁绿标记近红外荧光腹腔镜系统在腹腔镜胃癌根治术淋巴结清扫、重建后消化道血供评估及肿瘤定位中的应用价值。方法:回顾分析2017年12月至2019年1月收治的经胃镜及病理确诊的87例胃癌患者的临床资料,其中42例在吲哚菁绿标记近红外荧光腹腔镜系统下完成手术(观察组),45例行常规腹腔镜手术(对照组),对比术后两组淋巴结清扫与分检情况,并探讨吲哚菁绿标记在术中肿瘤定位及评估重建后消化道血供的作用。结果:观察组平均清扫淋巴结(36.71±11.43)枚,高于对照组的(31.22±8.67)枚(P<0.05);观察组检出直径<5 mm的淋巴结数量为(23.25±3.28)枚,高于对照组的(17.43±4.08)枚(P<0.05)。两组患者阳性淋巴结检出率差异无统计学意义(P>0.05)。根据吲哚菁绿评估血供的标准,观察组吻合口及十二指肠残端血供评分均达到3分以上,术后无一例发生消化道瘘。吲哚菁绿标记的胃浆膜层荧光范围边缘与肿瘤边缘的距离均超过胃癌根治术切除范围的标准距离。结论:吲哚菁绿标记近红外荧光腹腔镜胃癌根治术是安全、可行的,其淋巴结示踪作用可指导术者更精细、彻底地清扫淋巴结,术中应用吲哚菁绿评估吻合口血供可有效避免术后消化道瘘的发生,而且吲哚菁绿标记可精准定位肿瘤,进而指导腹腔镜胃癌根治术的切除范围。

Objective:To evaluate the clinical application of near-infrared(NIR)camera imaging with indocyanine green(ICG)-enhanced fluorescence technique in laparoscopic radical gastrectomy.Methods:Retrospective analysis was made on the clinical data of 87 patients who underwent laparoscopic radical gastrectomy with D2 lymph node dissection between Dec.2017 and Jan.2019 in Qilu hospital of Shandong University.42 patients received the radical gastrectomy under ICG-NIR laparoscopic system(observation group),and the rest 45 patients received the normal laparoscopic radical gastrectomy served as the control group.Through comparison of the lymph node harvested,the significance of ICG-NIR laparoscopic system in lymph node dissection,tumor localization and anastomotic perfusion were evaluated.Results:The mean number of dissected lymph nodes and lymph nodes smaller than 5 mm in diameter in observation group were both significantly higher than those in control group,respectively(36.71±11.43 vs.31.22±8.67,23.25±3.28 vs.17.43±4.08,P<0.05).While the number of metastatic lymph nodes showed no significant difference between the two groups(P>0.05).According to the Sherwinter grading system,the scores of anastomotic perfusion were all≥3,and no anastomotic fistula were observed in observation group.The mean distance between the borders of tumors and the fluorescent region area all exceeded the standard dissective distance of radical gastrectomy,which was helpful in tumor localization and determining the resection margin during laparoscopic gastrectomy.Conclusions:The NIR camera imaging with ICG-enhanced fluorescence technique in laparoscopic radical gastrectomy is safe and feasible,and it is helpful and effective for lymph node dissection,tumor localization and anastomotic perfusion evaluation during the laparoscopic radical gastrectomy.