三维可视化联合吲哚菁绿荧光影像技术在原发性肝癌诊治中的价值

Three-dimensional visualization combined with indocyanine green fluorescence imaging in diagnosis and treatment of primary hepatocellular carcinoma

目的研究三维可视化技术联合吲哚菁绿(ICG)荧光影像技术在原发性肝癌诊治的应用价值。方法收集2016年1月~2018年11月南方医科大学珠江医院肝胆外科收治的154例患者临床资料进行回顾性分析,分为实验组与对照组。实验组57例患者术前完成CT、GD-EOB-DTPA增强MRI、三维可视化并进行手术规划,术中使用ICG荧光影像实时侦测肿瘤部位、边界,肝内卫星癌灶、转移癌灶,根据术中荧光探查结果并联合三维可视化手术规划,完成最终手术方案;对照组97例患者进行常规手术评估及手术切除。对术前肿瘤的影像学信息、术中肿瘤的探测情况、术后实验室指标、病理信息及随访信息进行分析。结果实验组57例,术前CT影像学检查发现63个病灶;MRI发现70个病灶;术中ICG分子荧光发现80个病灶,比CT多发现的17个病灶中,病理证实10个为肝细胞癌,7个为肝硬化结节。实验组术中中位出血量为300(250)mL[M(QR)],少于对照组的400(390)mL(Z=2.291,P=0.022);两组患者均无严重并发症发生及围手术期死亡。实验组患者术后并发症发生率为21%(12/57),与对照组的48.4%(47/97)相比,差异有统计学意义(χ2=11.406,P=0.001)。实验组的24个月总体无瘤生存率为74.9%,而对照组总体无瘤生存率为28.9%,两组间的差异性具有统计学意义(P=0.022)。结论三维可视化技术联合ICG荧光影像能够为原发性肝癌治疗提供精确的术前诊断、手术规划及实施方案,以及术中微小肝癌侦测、精准导航,减少术后并发症发生,提高术后无瘤生存时间。

Objective To explore the value of three-dimensional visualization technology(3 DVT) combined with indocyanine green(ICG) fluorescence imaging in the diagnosis and treatment of primary hepatocellular carcinoma(HCC). Methods We retrospectively analyzed the clinical data of 154 patients with HCC admitted to the Department of Hepatobiliary Surgery,Zhujiang Hospital, Southern Medical University between January, 2016 and November, 2018. In 57 of the patients(3 DVT group), preoperative CT and Gd-EOB-DTPA-enhanced MRI were performed and 3 D visualization and surgical planning was carried out before the operation;intraoperative ICG florescence imaging was performed for real-time detection of the tumor location and demarcation, intrahepatic satellite lesions and metastases. According to the intraoperative fluorescent signals and3 D visualization-based surgical planning, the final surgical plan was determined. In the other 97 patients(control group),conventional surgical assessment and surgical resection of the tumor was carried out. The preoperative imaging findings,intraoperative tumor detection, postoperative laboratory results, pathological reports, and follow-up data of the patients were analyzed. Results In 3 DVT group, 63 and 70 lesions were detected by preoperative CT and MRI, respectively;compared with CT examination, intraoperative ICG florescence imaging revealed additional 17 lesions, among which 10 were pathologically confirmed as HCC and 7 as cirrhosis nodules. The median volume of bleeding was 300 mL in 3 DVT group, significantly less than that in the control group(400 mL;Z=2.291, P=0.022). In both groups, serious complications or perioperative death occurred in none of the patients. The incidence of postoperative complications was significantly lowed in 3 DVT group than in the control group [21%(12/57) vs 48.4%(47/97);χ2=11.406, P=0.001]. The overall disease-free survival rate at 2 years after the operation was significantly higher in 3 DVT group than in the control group(74.9% vs 28.9%, P=0.022).Conclusion 3 DVT combined with ICG fluorescence imaging allows precise preoperative diagnosis, surgical planning and implementation, intraoperative detection of small liver cancers and precise navigation for HCC treatment, thereby helping to reduce postoperative complications and improve the disease-free survival rate of the patients.