吲哚菁绿荧光成像在全腹腔镜远端胃癌根治术中的应用

Application of indocyanine green fluorescence imaging in totally laparoscopic distalgastrectomy for gastric cancer

目的:探讨吲哚菁绿(indocyanine green,ICG)荧光成像技术在全腹腔镜远端胃癌根治术中肿瘤定位及淋巴结清扫方面的应用价值。方法:回顾性收集2017年8月至2019年8月北京大学肿瘤医院收治的经胃镜及病理确诊的126例远端胃癌患者临床病理资料。其中62例患者在ICG标记近红外荧光腹腔镜下完成手术(观察组),64例行常规腹腔镜手术(对照组)。评估对比术前ICG标记与术中内镜定位的效果;对比两组淋巴结清扫与检获情况。结果:T1~2期观察组患者术中标本测量近端切缘距离(4.92±1.65)cm与对照组(4.76±1.66)cm相比差异无统计学意义(P=0.671)。T3~4期观察组患者第二站淋巴结清扫数目为(11.09±6.19)枚,高于对照组(8.89±4.35)枚(P=0.049);观察组破损淋巴结检出数量(0.74±0.46)枚少于对照组(1.27±1.22)枚(P=0.009)。结论:T1~2期胃癌患者行术前ICG标记可精准判断肿瘤边界,其肿瘤定位效果与术中胃镜相当,全腹腔镜手术时可指导选择合适的切除线。ICG在T3~4期胃癌的淋巴导航作用可指导术中更精细、完整、彻底地清扫淋巴结,增加淋巴结清扫数量,减少术中淋巴结的破损。

Objective:To explore the value of indocyanine green fluorescence imaging in tumor localization and lymph node dissection in totally laparoscopic distal gastrectomy.Methods:A retrospective cohort study was used.The clinical and pathological data of 126 patients with distal gastric cancer diagnosed through gastroscopy and pathology dated from August 2017 to August 2019 in Peking University Cancer Hospital&Institute was collected.Among these 126 patients,62 patients underwent laparoscopy with indocyanine green-labeled near-infrared fluorescence(observation group),and 64 patients underwent conventional laparoscopy(control group).The effects of preoperative indocyanine green-labeled,intraoperative endoscopic positioning and lymph node dissection were compared and evaluated between the two groups.Result:The distance of proximal incision margin was measured in patients with stage T1-2 gastric cancer.The observation group vs.the control group:(4.92±1.65 cm vs.4.76±1.66 cm,P=0.671).Number of second station lymph node dissection of patients with stage T3-4 gastric cancer in the observation group vs.the control group:(11.09±6.19 vs.8.89±4.35,P=0.049);the number of damaged lymph nodes in the observation group vs.the control group:(0.74±0.46 vs.1.27±1.22,P=0.009).Conclusions:The preoperative indocyanine green-fluorescence imaging in patients with stage T1-2 gastric cancer can accurately mark the tumor boundary,and its tumor localization effect is comparable with intraoperative gastroscopy in the surgery,which can guide the decision of the appropriate resection line during total laparoscopic surgery.Indocyanine green in the lymphatic navigation of T3-4 gastric cancer can guide the operation precisely and completely in the lymph node dissection,increase the number of lymph nodes dissection,and reduce the damage of lymph nodes during the operation.