近红外吲哚菁绿荧光技术用于机器人经肛全直肠系膜切除3例报告

Near infrared-indocyanine green assisted robotic transanal combined with transabdominal total mesorectal excision:A report of 3 cases

目的探讨近红外吲哚菁绿(NIR-ICG)荧光技术用于机器人经肛全直肠系膜切除(R-taTME)手术的可行性和价值。方法回顾性分析2019年3—6月陆军军医大学大坪医院普通外科收治的3例NIR-ICG荧光显影技术辅助R-taTME手术病人的临床资料。结果3例病人中男性2例,女性1例。年龄39~70岁。BMI为22.0~24.3,直肠肿瘤距离肛缘3~4 cm,手术时间为195~320 min,术中出血50~100 mL,清扫淋巴结数目为14~20枚。手术均顺利完成,无中转,术中无意外损伤等并发症。术后病理学检查示,直肠系膜均完整切除,环周切缘及吻合口近、远端未见癌细胞。术后住院7~9 d,恢复顺利。术后随访3个月,3例病人均无手术并发症,结合辅助检查未见肿瘤复发转移。结论NIR-ICG荧光显影技术用于R-taTME手术有利于术者把握正确的手术层面、保证系膜切除完整性,并可以进一步评估吻合口血流灌注,降低吻合口并发症发生风险。

ObjectiveTo explore the feasibility and advantages of near infrared-indocyanine green fluorescence(NIR-ICG)technique in robotic transanal total mesorectal resection(ta TME).MethodsThe clinical data of 3 patients whounderwent robot ta TME surgery assisted by NIR-ICG fluorescence technique in the Department of General Surgery,Daping Hospital,Army Medical University from March to June 2019 were analyzed retrospectively.ResultsAmong the3 patients,there were 2 males and 1 female.The age was 39 to 70 years old.The BMI was 22.0 to 24.3(23.2±1.2);thedistance of rectal tumor from anal margin ranged from 3 to 4 cm;the operation time was 195 to 320 min;theintraoperative blood loss was 50 to 100 m L,and the number of lymph nodes dissected was 14 to 20.All the operationswere completed successfully,there was no conversion,no accidental injury and other complications during the operation.Postoperative pathological examination showed that the mesorectum was resected completely and no cancer cells werefound in the circumferential margin and the proximal and distal end of the anastomosis.The postoperative hospital staywas 7 to 9 days,and the recovery was smooth.All three patients were followed up for 3 months.No complications,and norecurrence or metastasis was found in all cases.ConclusionThe application of NIR-ICG fluorescence technique inrobotic ta TME surgery can help the operator to grasp the correct anatomical plane,ensure the integrity of mesangialresection,further evaluate the blood supply of the anastomosis and reduce the risk of anastomotic complications.