吲哚菁绿在肝泡型包虫病13例手术中的应用

Use of indocyanine green in hepatic alveolar echinococcosis surgery: a retrospective study of 13 patients

目的探索吲哚菁绿荧光显像在肝泡型包虫病手术中的初步应用,总结术中使用经验。方法回顾分析2017年5月至2018年5月青海大学附属医院收治的13例肝泡型包虫病患者资料。所有患者均行开腹手术,术中均注射吲哚菁绿,通过荧光采集系统收集图像,且术后进行随访。结果13例患者中女性7例,男性6例,年龄(37.9±14.7)岁,体重(57.4±11.3)kg。除1例患者为汉族,其余均为藏族。泡型包虫病灶不显影,正常肝组织发出绿色荧光。检测到灶旁区域荧光强度介于正常肝组织与病灶之间,怀疑为边缘带(还需病理证实)。1例患者病灶周围出现环形荧光增强影。3例(23.1%,3/13)患者存在肝表面微小病灶,其中2例影像学检查未发现,1例CT表现为条索状钙化影。病灶切除后剩余肝脏均未发现残留病灶(除外微波消融的病灶)。所有患者均未出现术后并发症。7例患者完成随访,并未发现病灶复发。结论吲哚菁绿荧光显像在肝泡型包虫病外科手术中,在发现微小病灶、检测病灶残留等方面有优势,但还需要更多的研究进一步证实。

Objective To preliminarily study the use of indocyanine green in hepatic alveolar echinococcosis surgery. Methods The data of 13 patients with hepatic alveolar echinococcosis treated at the Affiliated Hospital of Qinghai University from May 2017 to May 2018 with laparotomy and intraoperative indocyanine green injection were retrospectively studied. Images were collected by the fluorescence acquisition system. Results There were 7 females and 6 males, with an average age of (37.9±14.7) years. The mean weight was (57.4±11.3) kg. Except for one patient of Han nationality, the rest were Tibetans. The lesions were not visualized but normal liver tissues emitted green fluorescence. One patient had a slightly enhanced fluorescence circle around the lesion. The fluorescence intensity of some areas were between normal liver tissues and the lesion, which were suspected to be the marginal zone (which needed to be confirmed by pathology). Three patients (23.1%, 3/13) had small lesions on the liver surface, 2 were not found by imaging examination, and 1 showed strip calcification on CT. No residual lesions in the liver (except for the microwave ablated lesions) were found after resection. No postoperative complications occurred in all the patients. Seven patients were followed up and no recurrence was found. Conclusions Fluorescence imaging of indocyanine green has the advantages of detecting small and residual lesions in surgery carried out for hepatic alveolar echinococcosis. More studies are needed to confirm the findings.