吲哚菁绿荧光显像技术联合腹腔镜Glisson蒂横断式肝段切除术治疗肝癌68例

Indocyanine green staining technique combined with laparoscopic hepatectomy with a Glisson pedicle approach for the treatment of liver cancer in 68 patients

目的探讨吲哚菁绿(ICG)荧光显像技术联合腹腔镜Glisson蒂横断式肝段切除术治疗肝癌的临床价值。方法回顾性分析余姚市人民医院2019年1月至2020年12月收治的原发性肝癌患者150例的临床资料, 根据手术方式分为A组(82例)、B组(68例), A组患者行腹腔镜Glisson蒂横断式肝段切除术, B组患者在A组患者基础上联合ICG荧光显像技术。观察并比较两组患者的手术相关情况、术后并发症情况以及手术前后肝功能指标变化情况。结果两组患者的首次排气时间、术后拔管时间、住院时间比较均差异无统计学意义(均P > 0.05)。B组患者手术时间[(205.04±35.01)min]、术中出血量[(230.05±17.53)mL]少于A组患者[(228.07±28.05)min、(255.07±19.00)mL](t=4.47、8.31, 均P < 0.05), 而R 0切除率[85.29%(58/68)]高于A组患者[70.73%(58/82)](χ^(2)=4.50, P < 0.05)。两组患者的术后并发症情况比较, 均差异无统计学意义(均P > 0.05)。术前, 两组患者谷氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBil)水平比较, 均差异无统计学意义(均P > 0.05);术后1 d, 两组患者ALT、AST、TBil水平均高于术前(均P < 0.05), 且A组ALT[(108.51±30.23)U/L]、AST[(107.66±26.93)U/L]、TBil[(32.16±4.73)μmol/L)]高于B组[(88.38±24.76)U/L、(86.85±19.74)U/L、(27.95±4.31)μmol/L)](t=4.40、5.30、5.65, 均P < 0.05);术后3 d, 两组患者ALT、AST、TBil水平均低于术后1 d, 但仍高于术前, 且A组ALT[(74.20±13.83)U/L)、AST[(65.22±9.68)U/L]、Tbil[(28.18±4.14)μmol/L]高于B组[(54.72±10.31)U/L、(55.41±7.63)U/L、(24.25±3.98)μmol/L](t=9.61、6.79、5.89, 均P < 0.05)。结论 ICG荧光显像技术虽具有一定局限性, 但该技术一定程度上提升肝切除术精准度, 再联合腹腔镜Glisson蒂横断式肝段切除术治疗肝癌更为安全、精确, 值得临床应用。

Objective To investigate the clinical value of indocyanine green(ICG)staining technique combined with laparoscopic hepatectomy with a Glisson pedicle approach in the treament of liver cancer.Methods The clinical data of 150 patients with primary liver cancer,who received treatment in Yuyao People's Hospital from January 2019 to December 2020,were retrospectively analyzed.Group A(n=82)and group B(n=68)were designated according to the surgery methods used.The group A was subject to laparoscopic hepatectomy with a Glisson pedicle approach.The group B received ICG staining technique combined with laparoscopic hepatectomy with a Glisson pedicle approach.Operation-related conditions,postoperative complications,and the change in liver function indexes after surgery relative to before surgery were compared between the two groups.Results There were no significant differences in the time taken to first anal exhaust,extubation time,and length of hospital stay between group A and group B(all P>0.05).Operative time and intraoperative bleeding in the group B were(205.04±35.01)minutes and(230.05±17.53)mL,respectively,which were significantly lower than those in the group A[(228.07±28.05)minutes,(255.07±19.00)mL,t=4.47,8.31,both P<0.05].R0 resection rate was significantly lower in group B than in group A[85.29%(58/68)vs.70.73%(58/82),χ^(2)=4.50,P<0.05].There were no significant differences in postoperative complications between the two groups(P>0.05).Before treatment,there were no significant differences in serum levels of alanine aminotransferase(ALT),aspartate transaminase(AST),and total bilirubin between the two groups(all P>0.05).At 1 day after surgery,serum ALT,AST,and TBil levels in each group were significantly increased compared with before surgery(all P<0.05).Furthermore,serum levels of ALT,AST and TBil in the group A were(108.51±30.23)U/L,(107.66±26.93)U/L,and(32.16±4.73)μmol/L,respectively,which were significantly higher than those in the group B[(88.38±24.76)U/L,(86.85±19.74)U/L,(27.95±4.31)μmol/L,t=4.40,5.30,5.65,all P<0.05].At 3 days after surgery,serum levels of ALT,AST,and TBil in each group were significantly lower than those at 1 day after surgery,but they were still higher than those before surgery.At 3 days after surgery,serum levels of ALT,AST and TBil in group A were(74.20±13.83)U/L,(65.22±9.68)U/L,and(28.18±4.14)μmol/L,respectively,which were significantly higher than those in group B[(54.72±10.31)U/L,(55.41±7.63)U/L,(24.25±3.98)μmol/L,t=9.61,6.79,5.89,all P<0.05].Conclusion Although the ICG staining technique has certain limitations,it can improve the accuracy of hepatectomy to a certain extent.ICG staining technique combined with laparoscopic hepatectomy with the Glisson pedicle approach is a safe and accurate treatment for liver cancer.The combined therapy is worthy of clinical application.