荧光腹腔镜在胃癌淋巴结清扫中的应用价值及难点剖析

Application value and difficulty analysis of fluorescence laparoscopy in lymphadenectomy of gastric cancer

近年来,随着腹腔镜技术的推广普及,荧光腹腔镜技术日益成熟,为精准临床示踪胃周淋巴结及预测癌细胞转移淋巴结提供了新的方法。大量文献证明,基于吲哚菁绿(ICG)的荧光腹腔镜辅助淋巴结诊疗技术能够显著提高淋巴结清扫效率,提升转移淋巴结的预判准确率,为胃肠外科医生提供更精准化的胃癌淋巴引流区清扫范围,从而避免了过度清扫及发生医源性损伤。虽然该技术在胃癌手术中的重要性不断提升,但ICG荧光显像的整体操作流程细节、标准化荧光探测设备乃至术后病理检查规范,尚有待进一步完善。未来仍需开展大样本、多中心、前瞻性随机对照研究,为明确荧光腹腔镜胃癌根治术淋巴结清扫的临床意义,提供更高级别的证据支持。

Gastric cancer is one of the most common gastrointestinal malignancies,and the incidence and mortality of gastric cancer remain high in China.In recent years,with the rapid popularization of laparoscopic technology,fluorescent laparoscopic technology is increasingly getting mature,providing a new method for accurate clinical tracing of lymph nodes and prediction of tumor metastasis lymph nodes.A large number of scientific research experiments and clinical trials have shown that,laparoscopic lymph node diagnosis technology based on the fluorescent indocyanine green(ICG)can significantly improve the efficiency of lymphadenectomy and prediction accuracy of lymph node metastasis,and can reveal a more accurate scope of lymphadenectomy in gastric cancer for surgeons,so as to avoid excessive adenectomy as well as iatrogenic injuries on patients.Although the status of the technology in gastric cancer surgery mentioned above continues improving,the overall operation process details of ICG fluorescence imaging,standardized fluorescence detecting equipment,and postoperative pathological examination process still need to be further optimized.