ICG荧光染色在HCC伴肝硬化腹腔镜解剖性切除术中的应用

Application of ICG fluorescence staining in laparoscopic surgery of HCC with cirrhosis

目的探讨吲哚箐绿(ICG)荧光染色在肝细胞癌(HCC)伴肝硬化腹腔镜解剖性切除术中的应用价值。方法选取拟实施腹腔镜下解剖性肝切除手术的患者96例,采用随机前瞻性单盲试验将患者分为观察组和对照组各48例;观察组采用ICG荧光染色下腹腔镜解剖性切除术,对照组采用常规腹腔镜下肝解剖切除术;对比两组患者的手术时间、切口长度、手术出血量、肝门阻断时间、术后肛门排气时间、引流管留置时间、手术前后的血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)、手术后并发症。结果观察组的手术时间、术中出血量、肝门阻断时间均低于对照组,差异有统计学意义(P<0.05);术后24 h,观察组的血清ALT、AST水平低于对照组(P<0.05);术后,观察组的并发症率与对照组比较,差异无统计学意义(P>0.05)。结论采用ICG荧光染色下腹腔镜解剖性切除术较常规腹腔镜下肝解剖切除有利于减少手术操作的难度、对术后肝功能的影响更小。

Aim To explore the application value of indocyanine green(ICG)fluorescent staining in laparoscopic anatomical resection of hepatocellular carcinoma(HCC)with liver cirrhosis.Methods A total of 96 patients who underwent laparoscopic anatomical hepatectomy were selected in our hospital,and randomized prospective singleblind test was used to divide the patients into observation group and control group,each with 48 cases;the observation group was treated with ICG fluorescence staining laparoscopic anatomical hepatectomy,and the control group was treated with conventional laparoscopic hepatic anatomical resection;compare the operation time,incision length,bleeding volume,hepatic hilar occlusion time,postoperative anus exhaust time,drainage tube retention time,before and after operation serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),direct bilirubin(DBIL),postoperative complications.Results The operation time,intraoperative blood loss,and hepatic portal occlusion time of the observation group were all lower than that of the control group,the difference was statistically significant(P<0.05);after 24 hours,the serum ALT and AST levels of the observation group were lower than those of the control group(P<0.05);postoperatively,the complication rate of the observation group was compared with the control group,and the difference was not statistically significant(P>0.05).Conclusion Laparoscopic anatomical resection under ICG fluorescence staining is more effective than conventional laparoscopic anatomical liver resection to reduce the difficulty of surgical operation and has less effect on liver function after surgery.