A-P-R三角解剖联合ICG荧光染色腹腔镜解剖性肝S5段切除术

Application of A-P-R triangle dissection combined with ICG fluorescence staining in laparoscopic anatomical S5 segmentectomy

目的探讨A-P-R三角解剖联合ICG荧光染色腹腔镜解剖性肝S5段切除术的安全性和可行性。方法回顾性分析2020年12月1日至2021年5月30日在中国医学科学院北京协和医学院附属肿瘤医院和胜利油田中心医院行腹腔镜肝S5段切除术的7例原发性肝癌患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男5例,女2例;年龄54~72岁,中位年龄65岁。术中解剖A-P-R三角联合ICG荧光染色显示肝段分界,实施腹腔镜下解剖性肝S5段切除术。观察患者术中及术后情况。结果所有患者均顺利完成手术,无中转开腹。其中单纯S5段切除3例,联合S4b段部分切除1例,联合S6段部分切除3例。手术时间中位数211(162~265)min,肝门阻断时间32(15~75)min,术中出血量150(50~300)ml,均无输血。术后住院时间7(3~14)d。术后无发生腹腔出血、肝衰竭等严重并发症。术后胆漏1例,保持通畅引流,术后20 d拔管。所有病例随访至投稿日,无肿瘤复发转移,无死亡。结论采用A-P-R三角解剖联合ICG荧光染色辅助腹腔镜解剖性肝S5段切除术安全、可行。

Objective To evaluate the safety and feasibility of A-P-R triangle dissection combined with ICG fluorescence staining in laparoscopic anatomical S5 segmentectomy.Methods Clinical data of 7 patients with primary liver cancer undergoing laparoscopic anatomical S5 segmentectomy in Cancer Hospital of Peking Union Medical College,Chinese Academy of Medical Sciences and Shengli Oilfield Central Hospital from December 1,2020 to May 30,2021 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,5 patients were male and 2 female,aged from 54 to 72 years,with a median age of 65 years.Intraoperatively,A-P-R triangle dissection combined with ICG fluorescence staining were adopted to display the boundary of liver segments,and laparoscopic anatomical S5 segmentectomy was performed.Intraoperative and postoperative conditions of all patients were observed.Results All the patients underwent the surgery successfully without conversion to open surgery.Among them,3 cases underwent S5 segmentectomy alone,1 case underwent S5 segmentectomy combined with partial S4b segmentectomy and 3 cases of S5 segmentectomy combined with partial S6 segmentectomy,respectively.The median operation time was 211(162-265)min,the hepatic portal occlusion time was 32(15-75)min,and intraoperative blood loss was 150(50-300)ml.No blood transfusion was delivered.The length of postoperative hospital stay was 7(3-14)d.No severe complications,such as abdominal hemorrhage and liver failure,occurred after surgery.Postoperative bile leakage occurred in 1 case,who received drainage and extubation at postoperative 20 d.All patients were followed up till the day of manuscript submission.No tumor recurrence,metastasis or death was reported.Conclusions It is safe and feasible to perform A-P-R triangle dissection combined with ICG fluorescence staining in laparoscopic anatomical S5 segmentectomy.