吲哚氰绿荧光示踪技术在肝癌解剖性肝切除中的应用

Application of indocyanine green fluorescence imaging in anatomical hepatectomy for hepatocellular carcinoma

目的探讨吲哚氰绿(ICG)荧光示踪技术在肝细胞癌(肝癌)解剖性肝切除中的应用价值。方法本前瞻性研究对象为2017年6月至2018年7月在中国科学技术大学附属第一医院行解剖性肝切除的55例肝癌患者。患者均签署知情同意书,符合医学伦理学规定。按照随机数字表法随机分为ICG示踪组(28例)和对照组(27例)。其中ICG示踪组男23例,女5例;平均年龄(54±12)岁;应用ICG荧光染色示踪技术行解剖性肝切除。对照组男22例,女5例;年龄(58±12)岁;行常规解剖性肝切除。两组手术相关指标比较采用t检验或χ~2检验。结果 ICG示踪组手术时间为(245±62)min,明显长于对照组的(198±60)min(t=2.857,P<0.05)。ICG示踪组术中输血率7%(2/28),明显低于对照组的45%(12/22)(χ~2=10.079,P<0.05)。ICG示踪组术后引流拔管时间、最高体温分别为(6.3±2.4) d、(37.7±0.4)℃,明显少于对照组的(8.4±4.4) d、(38.0±0.6)℃(t=-2.194,-2.179;P<0.05)。结论ICG荧光示踪技术可清楚界定肝切除范围,加速患者术后康复,可作为解剖性肝切除的一种辅助手段。

Objective To investigate the application value of indocyanine green (ICG) fluorescence imaging in anatomical hepatectomy for hepatocellular carcinoma (HCC). Methods 55 patients with HCC who underwent anatomical hepatectomy in the First Affiliated Hospital of University of Science and Technology of China from June 2017 to July 2018 were enrolled in this prospective study. The informed consents of all patients were obtained and the local ethical committee approval was received. According to the random number table method, all patients were randomly divided into ICG group (n=28) and control group (n=27). In ICG group, 23 patients were male and 5 female, aged (54±12) years on average. Anatomical hepatectomy was performed using ICG fluorescence imaging. In control group, 22 patients were male and 5 female, aged (58± 12) years on average. Conventional anatomical hepatectomy was performed. The surgery-related parameters were statistically compared between two groups by using t test or Chi-square test. Results In ICG group, the operation time was (245±62) min, significantly longer than (198±60) min in control group (t=2.857, P<0.05). In ICG group, the percentage of intraoperative blood transfusion was 7%(2/28), significantly lower than 45%(12/22) in control group (χ2=10.079, P<0.05). In ICG group, the drainage extubation time was (6.3±2.4) d and the highest body temperature was (37.7±0.4)℃ respectively, significantly less than (8.4±4.4) d and (38.0± 0.6)℃ in control group (t=-2.194,-2.179;P<0.05). Conclusions ICG fluorescence imaging can clearly define the range of liver resection and accelerate the postoperative rehabilitation of patients, which can serve as an auxiliary approach for anatomical hepatectomy.