腹腔镜解剖性肝切除术中荧光染色意外及对策

Unexpected ICG fluorescence staining in laparoscopic anatomic resection,how to deal with it?

吲哚菁绿(ICG)荧光染色已成为精准腹腔镜解剖性肝切除术的重要技术手段,其基本策略包括负染法及正染法。负染法常见Glisson蒂阻断区域仍有染色、荧光染色渗透扩散等染色意外现象。正染法染色意外包括多支、细小门静脉分支穿刺困难、部分目标区域不染色、染色部位及范围与预期不符等。当染色与预期不符时,虽然可以便捷地切换为白光模式,利用传统方法行解剖性肝切除;但建议对ICG染色情况进行研判,尽可能利用ICG荧光染色所提供的信息,根据实际情况采用部分荧光界线、正负染法互换、切换彩色分段模式(CSF)或黑白模式提高对比度等策略应对。

Indocyanine green(ICG)fluorescence staining has become an important technique for precise laparoscopic anatomical hepatectomy.There are two basic strategies:negative staining and positive staining Negative staining could be gradually contaminated due to collateral circulation.The unexpected situation of positive staining includes difficult puncture of multiple and tiny portal branches,no staining on part of the target area,unexpected site and extent of staining,etc.When the staining is not as expected,anatomic liver resection can be performed using traditional methods by easily switching to white light mode.However,it is recommended to analyze the situation of ICG staining,use the information provided by ICG fluorescent staining as much as possible,and adopt strategies such as using partial fluorescence boundary,exchange of positive and negative staining,switching color segmentation mode(CSF)or black and white mode to improve contrast according to the actual situation.