吲哚菁绿近红外光成像技术在微创食管癌根治术中行淋巴引流显影的应用

Application of indocyanine green near-infrared fuorescence imaging guided lymphatic mapping in minimally invasive esophagectomy

目的:探索微创食管癌根治术(minimally invasive esophagectomy,MIE)中,应用吲哚菁绿(indocyanine green,ICG)近红外光成像技术,对食管癌手术中淋巴引流成像效果的影响因素。方法:收集2020年10月—2021年10月行荧光腔镜MIE入组患者120例,术前均行胃镜下食管肿瘤周围ICG黏膜下注射,分为ICG注射浓度对比组(ICG浓度对比组)39例和ICG注射间隔时间显影组(ICG间隔时间组)81例,观察比较两组淋巴引流的显影效果。结果:(1)ICG浓度对比组:ICG低浓度(2.5 mg/mL)胃镜下食管肿瘤周围黏膜下注射较高浓度(5 mg/mL)更易染色成功(P=0.001)。(2)ICG间隔时间组:胃镜下自ICG溶液(2.5 mg/mL)注射至荧光腔镜MIE的间隔时间会影响淋巴引流成像效果。ICG最佳显示间隔时间为143 min,其灵敏度为84.7%,特异度为93.3%,受试者工作特征曲线下面积为0.945,95%CI:0.895~0.995(P<0.001)。结论:ICG近红外光成像技术可用于荧光腔镜MIE术中的淋巴引流成像。低浓度ICG(2.5 mg/mL)术前胃镜下食管肿瘤周围黏膜下注射可获得较高的染色成功率;胃镜下ICG注射到接受手术的间隔时间与成像效果有关,最佳时间间隔为143 min。

Objective:To explore the technique of indocyanine green(ICG)near-infrared imaging for lymphatic drainage imaging in minimally invasive esophagectomy(MIE).Methods:An analysis of 120 patients enrolled in the group treated with fluoroscopic MIE from October 2020 to October 2021,all patients underwent submucosal injection of ICG around the endoscopic esophageal tumor before surgery.39 patients were divided into a high concentration group and a low concentration group.The time interval between endoscopic ICG injection and undergoing fluoroscopic MIE was counted.The effects of lymphatic drainage imaging were observed and compared between two groups.Results:(1)Preoperative low concentration(2.5 mg/mL)ICG endoscopic submucosal injection around esophageal tumor was more likely to stain successfully than high concentration(5 mg/mL)(P=0.001).(2)The interval between endoscopic ICG injection and undergoing fluoroscopic MIE would affect the lymphatic drainage imaging effect.The optimal time interval was 143 minutes.The sensitivity was 84.7%,the specificity was 93.3%,the area under the receiver operating characteristic curve area under curve 0.945,95%CI:0.895-0.995(P<0.001).Conclusion:ICG near-infrared imaging technique can be used for lymphatic drainage imaging in fluoroscopic MIE,and preoperative endoscopic submucosal injection around esophageal tumors with low concentration of ICG(2.5 mg/mL)can achieve a high staining success rate;the interval between endoscopic ICG injection and receiving surgery is related to the imaging effect,and the optimal time interval is 143 minutes.