根治性前列腺切除术中应用荧光成像技术定位神经血管束的研究进展

Fluorescence imaging in intraoperative visualization of neurovascular bundles(NVBs)surrounding the prostate:a literature review

保留勃起功能是根治性前列腺切除术的重要目标。由于与勃起功能密切相关的神经血管束难以被识别和定位,在术中易受到损伤,患者术后勃起功能障碍的发生率较高。神经电刺激、超声和MRI等手段在术中实时定位神经血管束时均有较大局限性。荧光成像技术在外科手术导航应用研究中的不断深入为实现神经血管束的术中实时可视化提供了可能。目前,国际上已有众多针对轴突、髓鞘、神经束膜和滋养血管等神经内部结构的荧光显像剂,它们在与神经的亲和力和成像效果上各具特点。已有部分亲脂性小分子、恶嗪类染料和多肽-染料偶联物在啮齿类动物体内或人离体标本中实现了对前列腺周围自主神经的成像,非特异性神经血管染料吲哚菁绿已在临床上被用于辅助保留性神经的根治性前列腺切除术。本文对荧光神经成像技术和其在根治性前列腺切除术中用于实时定位神经血管束的相关研究作一综述。

Preservation of erectile function is an important goal of radical prostatectomy.The neurovascular bundles(NVBs),which is closely related to erectile function,are quite susceptible to intraoperative injury because it is difficult to be identified and localized during surgical process.As a result,long-term postoperative potency rate is not satisfying.Techniques of monitoring pro-erectile neurovascular bundles,such as electrical stimulation,ultrasound and MRI have significant limitations in the context of real-time identification during operation.Advances of fluorescence imaging in the surgical navigation field has made it possible to achieve real-time visualization of NVBs in vivo.At present,there have already been many fluorescent agents worldwide targeting different structures within nerves,such as the axon,myelin,perineurium and vaso nervorum,and they varied in their affinity to nerves and imaging efficacies.Some lipophilic molecules,oxazine dyes and peptide-dye conjugates have successfully visualized in periprostatic autonomic nerves in rodents or in human prostate specimen.Indocyanine Green(ICG),a non-specific neurovascular dye,has already been used in clinical setting to guide during nerve-sparing radical prostatectomy.This review focused on fluorescent nerve imaging technique and its application in research on real-time imaging of NVBs in radical prostatectomy.