荧光导航腹腔镜肝脏肿瘤切除吲哚菁绿术前给药时机:单中心60例经验

Laparoscopic liver tumor resection under indocyanine green fluorescent navigation: A single center experience of 60 patients to study the optimal preoperative injection timing of indocyanine green

目的探讨吲哚菁绿荧光导航腹腔镜下肝脏肿瘤切除的术前给药时机,以获得术中满意的荧光显影效果。方法回顾性分析浙江大学医学院附属邵逸夫医院2017年4月-2018年10月60例肝脏肿瘤患者腹腔镜肝切除术中荧光显影情况,就显影效果进行简易分级,分析其ICGR15值和术前给药天数,观察患者在不同时间给药的术中荧光显像效果。结果60例患者中59例行腹腔镜下肝切除术,1例中转开腹。术中荧光显影总体满意率73.4%(44/60)。ICGR15≤7%的患者,术前给药时间超过48h时更容易获得较好的显影,而术前给药时间超过5天时,能够获得满意的显影效果。ICGR15>7%的患者,短时间术前给药(<6天)时术中荧光显影多不满意;当术前给药时间≥6天时,可获得相对较好显影。结论在不改变患者术前ICG给药剂量的前提下,依据患者ICGR15的不同,适当延长患者的术前给药时间,可获得较好的术中肝脏肿瘤荧光显影效果。具体时间窗口尚需通过更大宗的病例研究进一步明确。

Objective To study the optimal timing of preoperative injection of indocyanine green in laparoscopic liver tumor resection under indocyanine green fluorescent navigation to obtain the most satisfactory fluorescence imaging effects. Methods 60 patients with liver tumors who underwent laparoscopic hepatectomy from April 2017 to October 2018 were retrospectively studied on the intraoperative fluorescence imaging effects. A simple grading of the fluorescence imaging effects was developed. The ICG R15 and preoperative injection times of ICG were correlated with the intraoperative fluorescence imaging effects. Results Of 60 patients with liver tumors, 59 patients underwent laparoscopic liver resection and one patient was converted to open surgery. The overall satisfaction rate of intraoperative fluorescence imaging was 73.4%(44/60). In the patients with an ICG R15 rate ≤ 7%, it was easier to obtain good fluorescence imagings when the preoperative administration time was longer than 48 hours. Even when the preoperative administration time was longer than 5 days, satisfactory fluorescence imaging effect could still be obtained in these patients. In the patients with an ICG R15 rate > 7%, intraoperative fluorescence imagings were unsatisfactory when the administration time was less than 6 days. Relative better imagings were obtained in these patients when the preoperative administration time was more than 6 days. Conclusions When the pre-operative ICG injection dose was not changed, the preoperative administration time should be adjusted according to the value of the ICG R15 to obtain better intraoperative fluorescence imaging effects of the liver tumors. The optimal timing needs to be further studied by a large case study.