吲哚菁绿在机器人肝脏FNH切除术中的应用

Application of indocyanine green in robotic resection of liver FNH

目的总结应用吲哚菁绿(indocyanine green,ICG)在机器人肝脏局灶性结节性增生(focal nodular hyperplasia,FNH)切除术中荧光显影定位导航的方法。方法回顾性分析解放军总医院肝胆胰外科医学部2018年5月至2020年10月行ICG荧光显影术中导航机器人肝脏FNH切除患者的临床病理资料。根据肿瘤大小将患者分为肿瘤<5 cm组和肿瘤≥5 cm组。术前48 h,患者经肘正中静脉注射ICG,剂量0.25 mg/kg。术中在机器人荧光模式下实时定位肿瘤边界并联合应用术中超声完成FNH切除术。结果36例患者中,男17例、女19例,平均年龄28.7岁。35例完成机器人肿瘤切除术、1例中转开腹。肿瘤平均直径(5.9±4.4)cm,13例患者肿瘤<5 cm、23例患者肿瘤≥5 cm。机器人手术患者的中位手术时间120 min,中位术中出血量50 ml,术后平均住院时间3.9 d。两组的手术时间、术中出血量和术后平均住院时间比较,差异有统计学意义(P<0.05)。结论ICG荧光显影术中可实时显示肝脏FNH肿瘤边界,引导外科医师机器人下完整切除肿瘤。

Objective To summarize the application of indocyanine green(ICG)in localization of tumor and determination of resection boundary in robotic resection of liver focal nodular hyperplasia(FNH).Methods The clinical and pathological data of patients who underwent robotic resection of liver FNH from May 2018 to Oct.2020 were retrospectively analyzed.According to the tumor size,the patients were divided into<5 cm and≥5 cm groups.Two days before the operation,ICG was injected through the median elbow vein in all the patients at a dose of 0.25 mg/kg.The position and boundary of FNH in the liver was located by the fluorescence mode of da Vinci Si robotic surgery system and combined with intraoperative ultrasound examination when necessary.Results There were 36 patients in this study,including 17 males and 19 females,with an average age of 28.7 years.35 patients completed robotic tumor resection,and 1 patient was converted to open surgery.The average diameter of tumor was(5.9±4.4)cm,13 cases were less than 5 cm,23 cases were more than 5 cm.The median operation time of robotic resection group was 120 min,and the median blood loss was 50 ml,and the average postoperative hospital stay was 3.9 days.Compared with≥5 cm group,<5 cm group had shorter operation time and less bleeding and shorter postoperative hospital stay(P<0.05).Conclusions ICG fluorescence imaging can display the FNH tumor boundary in real time,and guide the surgeon to perform radical resection of tumor by robotic surgery system.