吲哚菁绿示踪剂引导的D2淋巴结清扫在胃癌手术中的应用

Application of D2 lymph node dissection guided by indocyanine green tracer in the operation of gastric cancer

目的探讨吲哚菁绿(indocyanine green,ICG)引导的D2淋巴结清扫术在胃癌根治术中应用的安全性和有效性。方法回顾性分析2018年12月至2020年1月期间在武汉大学中南医院胃肠外科进行腹腔镜胃癌根治术的44例胃癌病人资料(术前临床肿瘤分期cT1~cT4a、N0/+、M0期)。将病人分为ICG组(20例)和非ICG组(24例)。比较两组之间的淋巴结检出数目、手术时间、术中出血量、术后住院时间及病理结果等。结果ICG组与非ICG组病人的一般病例资料及临床病理分期的差异无统计学意义。清扫淋巴结总数目:ICG组为(32.8±11.2)枚,非ICG组为(30.4±9.9)枚,两组比较差异无统计学意义(P=0.45)。手术时间ICG组为(126.4±23.6)min,非ICG组为(118.2±30.4)min,两组比较差异无统计学意义(P=0.25);术中出血量ICG组为(46.4±12.6)ml,非ICG组为(36.6±21.5)ml,两组比较差异无统计学意义(P=0.33);术后恢复时间ICG组为(8.6±2.6)d,非ICG组为(7.8±1.1)d,两组比较差异无统计学意义(P=0.18)。结论ICG在腹腔镜胃癌根治术中有较好的淋巴结显示作用,有利于手术医师进行系统淋巴结清扫,同时ICG在腹腔镜手术中的使用也是安全的。

Objective To evaluate the safety and efficacy of indocyanine green(ICG)-guided D2 lymph node dissection in radical gastrectomy of gastric cancer.Methods From December 2018 to January 2020,patients with gastric cancer(preoperative clinical tumor stage cT1-cT4a,N0/+,M0)who underwent laparoscopic radical gastrectomy in the Department of Gastrointestinal Surgery,Zhongnan Hospital of Wuhan University were retrospectively analyzed.The patients were divided into ICG group(20 patients)and non-ICG group(24 patients).The number of detected lymph nodes,operation time,intraoperative blood loss,postoperative hospital stay and pathological results were compared between the two groups.Results There was no significant difference in general case data and clinicopathological stage between ICG group and non-ICG group.There was no significant difference in the number of lymph nodes dissected between the ICG group and the non-ICG group(mean number of lymph nodes dissected:32.8±11.2 in the ICG group vs.30.4±9.9 in the non-ICG group,P=0.45).The mean operation time between the two groups[(126.4±23.6)min in the ICG group vs.(118.2±30.4)min in the non-ICG group,P=0.25],intraoperative blood loss[(46.4±12.6)ml in the ICG group vs.(36.6±21.5)ml in the non-ICG group,P=0.33],and postoperative recovery time[(8.6±2.6)days in the ICG group vs.(7.8±1.1)days in the non-ICG group,P=0.18]were not statistically significant.Conclusion ICG plays a better role in lymph node display in laparoscopic radical gastrectomy,which is beneficial for surgeons to perform systematic lymph node dissection.Meanwhile,ICG is also safe to be used in laparoscopic surgery.