荧光法在单孔胸腔镜解剖性肺段切除术中识别段间交界线的可行性研究

Feasibility Investigation of Fluorescence Method in Uniport Thoracoscopic Anatomical Segmentectomy for Identifying the Intersegmental Boundary Line

背景与目的肺段切除术逐渐成为影像学上表现为早期肺癌的肺部小结节的标准手术方式之一。本研究通过对比单孔胸腔镜下荧光法与改良膨胀萎陷法在界定段间交界线的围手术期结果,评估荧光法应用于肺段切除术的有效性和可行性。方法回顾性分析2018年2月-2020年8月期间在南京胸科医院胸外科接受单孔胸腔镜肺段切除术的连续198例患者的围手术期数据。在三维智能交互式定性和定量分析(intelligent/interactive qualitative and quantitative analysis-three dimensional,IQQA-3D)图像分析系统的指导下,精确识别和解剖离断靶段结构,继而通过荧光法或改良膨胀萎陷法确认段间交界线。评价两种方法的临床疗效和术后并发症。结果荧光法组有98%的患者呈现出清晰的段间交界线,甚至部分患者使用了较低剂量的吲哚菁绿(indocyanine green,ICG)。相比改良膨胀萎陷法,荧光法的段间交界线的清晰呈现时间[(23.59±4.47)s vs(1,026.80±318.34)s,P<0.01]和手术时间[(89.3±31.6)min vs(112.9±33.3)min,P<0.01]明显缩短。改良膨胀萎陷法术后长时间漏气的发生率高于荧光法组(8.0%vs 26.5%,P=0.025)。两组的术中失血量、术后胸管持续引流时间、术后住院时间、手术切缘宽度及其他术后并发症均无明显差异(P均>0.05)。结论荧光法可以高度准确地识别段间交界线,使得解剖性肺段切除术更加简单、更加快速,因此荧光法有可能成为一种可行且有效的技术,以提高单孔胸腔镜肺段切除术的质量。

Background and objective Segmentectomy has gradually become one of the standard surgical methods for small pulmonary nodules with early lung cancer on imaging.This study aimed to investigate the perioperative outcomes of patients who underwent uniport video-assisted thoracoscopic surgery(VATS)segmentectomy for identifying the intersegmental boundary line(IBL)by the near-infrared fluorescence imaging with intravenous indocyanine green(ICG)method or the modified inflation-deflation(MID)method and assess the feasibility and effectiveness of the ICG fluorescence(ICGF)-based method.Methods We retrospectively analyzed the perioperative data in total 198 consecutive patients who underwent uniport VATS segmentectomy between February 2018 and August 2020.With the guidance of preoperative intelligent/interactive qualitative and quantitative analysis-three dimensional(IQQA-3D),the targeted segment structures could be precisely identified and dissected,and then the IBL was confirmed by ICGF-based method or MID method.Clinical effectiveness and postoperative complications of the two methods were evaluated.Results An IBL was visible in 98%of patients by the ICGFbased group,even with the low-doses of ICG.The ICGF-based group was significantly associated with the shorter IBL clear presentation time[(23.59±4.47)s vs(1,026.80±318.34)s](P<0.01)and operative time[(89.3±31.6)min vs(112.9±33.3)min](P<0.01),compared to the MID group.The incidence of postoperative prolonged air leaks was higher in the MID group than in the ICGF-based group(8.0%vs 26.5%,P=0.025).There were no significant differences in bleeding volume,chest tube duration,postoperative hospital stays,surgical margin width and other postoperative complications(P>0.05).Conclusion The ICGF-based method could highly accurately identify the IBL and make anatomical segmentectomy easier and faster,and therefore has the potential to be a feasible and effective technique to facilitate the quality of uniport VATS segmentectomy.