荧光显影技术在机器人辅助前列腺癌根治术中的应用

Preliminary clinical experiences of fluorescence imaging in Robot-assisted radical prostatectomy

目的探讨经会阴穿刺注射吲哚菁绿(ICG)介导的组织荧光显影识别技术在机器人辅助前列腺癌根治术与盆腔淋巴清扫术的临床应用的可行性及意义。方法回顾性分析2018年1月到2018年12月期间在山西医科大学第一医院接受机器人辅助腹腔镜前列腺根治术的前列腺癌患者的临床资料,其中应用淋巴显影技术患者30例(研究组),平均年龄(62±8)岁;体质量指数(22.8±1.4)kg/m2;前列腺体积(57.5±1.4)ml;术前PSA(81.2±1.2)ng/dl;Gleason评分≤7分的患者占46.73%。对照组30例,平均年龄(61±7)岁;体质量指数(22.7±1.3)kg/m2;前列腺体积(56.9±1.3)ml;术前PSA(82.4±1.2)ng/dl;Gleason评分≤7分的患者占43.30%。两组患者一般资料比较差异均无统计学意义(P>0.05)。研究组术中采用前列腺穿刺注射5 mg ICG溶液,应用达芬奇手术机器人配备的Firefly摄像头进行荧光显影组织的观察及切除,所切除组织进行标记计数并送病理检查。收集术中指标、术后并发症情况,随访终点为生化复发。结果30例研究组患者接受了经会阴前列腺穿刺注药,1例出现了ICG泄漏情况。30例患者前列腺腺体显影良好且与周围非荧光显影组织区别明显。30例患者均观察到了淋巴结组区域有荧光显影,荧光显影的特征为细管状及团块状,经术后病理明确为淋巴管及淋巴结组织。所有患者切除下的淋巴结总数为970枚,研究组526枚,明显多于对照组444枚。研究组每例患者较对照组多检出2.7枚淋巴结(17.5枚/例vs 14.8枚/例)。研究组显影淋巴结419枚,未显影107枚,荧光识别率达89.6%。两组术后控尿率96.7%,研究组淋巴漏发生率6.7%(16.7%),生化复发率3.3%(13.3%),两组之间差异无统计学意义。结论经会阴途径前列腺内注射ICG介导的荧光显影方法稳定可靠,安全易行,荧光显影识别淋巴组织敏感性高,但缺乏前列腺癌特异性。

Objective To explore the clinical utilization value of fluorescent lymphnodes detection with Indocyanine Green(ICG)in robotic prostatectomy and pelvic lymphnode dissection.Methods In this study,from Jan.2018 to Dec.2018,60 prostate cancer patients,30 in fluorescence guided surgery group and 30 in control group,who underwent robotic prostatectomy in the First Hospital of Shanxi Medical University.And their clinical data were retrospectively analyzed.Among 30 patients with fluorescence guided surgery,the average age was(62±8)years,BMI was(22.8±1.4)kg/m2,PSA level was(81.2±1.2)ng/dl,prostatic volume was(57.5±1.4)ml and 14(46.73%)patients with Gleason score≤7.In the control group,the average age was(61±7)years,BMI was(22.7±1.3)kg/m2,PSA level was(82.4±1.2)ng/dl,prostatic volume was(56.9±1.3)ml and 11(43.30%)patients with Gleason score≤7.All parameters were comparable between the two groups.Patients in study group,before the prostatectomy,received endorectal ultrasound guided transperineal prostatic injection of ICG(5 mg).Firefly endoscopy were utilized during the fluorescent lymph nodes resection.Resected lymph tissue was marked,counted and sent to pathology.Intraoperative and postoperative data was collected,no significant differences were found in incidence of advert events and biochemical reccurence.Results Among patients received endorectal ultrasound guided transperineal prostate ICG injection,one case had leakage.In all 30 patients,it was able to identify fluorescent prostatic capsule which were well distincted from adjacent structures.Fluorescence lymph node(FLN)packets were observed in all 30 patients and fluorescence guided resected tissue was pathologically confirmed lymph tissue.There were total 970 lymph nodes resected in both groups,526(17.5/person)in study groups,which was significantly more than the control group 444(14.8/person).Total fluorescence rate in study group was 89.6%.Postoperative complications and incidence of reccurence was comparable.Conclusion Transperineal injection ICG induced fluorescence guided robotic assisted prostatectomy was proved stable and reliable in this study which could be used as guidance of surgical resection strategy.