三维计算机断层扫描支气管血管成像联合吲哚菁绿反染法在胸腔镜肺段切除术中的应用

Application of three-dimensional computed tomography-bronchography and angiography combined with indocyanine green reverse staining in video-assisted thoracic segmentectomy

目的评估三维计算机断层扫描支气管血管成像(three-dimensional computed tomography-bronchography and angiography,3D-CTBA)联合吲哚菁绿(indocyanine green,ICG)反染法在电视辅助胸腔镜手术(video-assisted thoracic surgery,VATS)肺段切除术中的安全性及临床应用价值。方法回顾性分析苏北人民医院2020年1月—2021年1月125例行VATS肺段切除术患者的临床资料,其中男40例(32.0%)、女85例(68.0%),平均年龄(54.8±11.1)岁。结果全组患者均在3D-CTBA和ICG反染法联合应用下顺利完成手术,手术过程与术前模拟基本一致。段间平面均成功显示,且ICG注入未见不良反应。125例患者共取出130枚病理标本,平均手术时间(126.8±41.9)min,平均首次发出荧光时间(22.7±4.9)s,从开始标记到标记结束的平均时间为(65.6±20.3)s,中位术中出血量20.0(10.0~400.0)m L,术后住院时间5.6(4.0~28.0)d,胸腔引流管放置时间3.2(2.0~25.0)d。病理结果显示微浸润性腺癌最多(50/130,38.5%),其次为浸润性腺癌(48/130,36.9%);转移性肿瘤3枚(3/130,2.3%)。结论3D-CTBA联合ICG反染法行VATS肺段切除术是一种安全可行的方法,可在临床推广应用。

Objective To evaluate the security and clinical value of the combination of three-dimensional computed tomography-bronchography and angiography(3D-CTBA)and indocyanine green(ICG)staining in videoassisted thoracic surgery(VATS)segmentectomy.Methods The clinical data of 125 patients who received VATS segmentectomy from January 2020 to January 2021 in our hospital were retrospectively analyzed.There were 40(32.0%)males and 85(68.0%)females with an average age of 54.8±11.1 years.Results The procedure was almost identical to the preoperative simulation.All intersegment planes were displayed successfully by ICG reverse staining method.There was no allergic patient.A total of 130 pathological specimens were obtained from the 125 patients.The mean operation time was 126.8±41.9 min,the time of first appearance of fluorescence was 22.7±4.9 s,the mean mark time was 65.6±20.3 s,the median blood loss was 20.0(10.0-400.0)m L,the postoperative hospital stay was 5.6(4.0-28.0)d,and the postoperative retention of chest tube time was 3.2(2.0-25.0)d.Pathological results showed that microinvasive adenocarcinoma was the most common type(38.5%,50/130),followed by invasive adenocarcinoma(36.9%,48/130);there were 3 metastatic tumors(3/130,2.3%).Conclusion The combination of 3D-CTBA and ICG reverse staining is proved to be a safe,necessary and feasible method.It solves the difficult work encountered in the procedure of segmentectomy,and it is worth popularizing and applying in clinic.