ICG荧光融合影像技术在肝癌腹腔镜解剖性肝切除术中的应用

Application of fusion ICG-fluorescence imaging in laparoscopic anatomical hepatectomy for primary liver cancer

目的探讨ICG荧光融合影像技术(FIGFI)在原发性肝癌(肝癌)腹腔镜解剖性肝切除术(LAH)中的应用价值。方法回顾性分析2018年3月至2021年12月在南通市第三人民医院行解剖性肝切除术的70例肝癌患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男47例,女23例;年龄35~76岁,中位年龄58岁。根据不同手术方式分为FIGFI-LAH组(31例)和LAH组(39例)。比较两组术前情况、中转开腹率、肝门阻断时间、手术时间、术中出血量、术后并发症、术后复发及生存情况等。切缘阳性率比较采用χ2检验。采用Kaplan-Meier法绘制生存曲线,1、2、3年复发率和生存率比较采用Z检验。结果FIGFI-LAH组中转开腹1例,LAH组2例,其余患者均顺利完成手术。FIGFI-LAH组切缘阳性率为3%(1/31),明显低于LAH组的21%(8/39)(χ^(2)=4.607,P<0.05)。FIGFI-LAH组术后1、2、3年累积复发率分别为3%、14%、22%,LAH组相应为5%、17%、72%,FIGFI-LAH组术后3年累积复发率明显低于LAH组(Z=-5.705,P<0.05)。FIGFI-LAH组术后1、2、3年累积生存率分别为100%、100%、84%,LAH组相应为97%、91%、53%,FIGFI-LAH组术后3年累积生存率明显高于LAH组(Z=4.478,P<0.05)。结论应用FIGFI技术辅助LAH是安全可行的,能实现肿瘤切缘的可视化和精准肝切除,有效降低切缘阳性率,有助于提高肝癌患者术后远期生存率。

Objective To evaluate the application value of fusion ICG-fluorescence imaging(FIGFI)in laparoscopic anatomical hepatectomy(LAH)for primary liver cancer(PLC).Methods Clinical data of 70 PLC patients who underwent LAH in the Third People's Hospital Affiliated to Nantong University from March 2018 to December 2021 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,47 patients were male and 23 female,aged from 35 to 76 years,with a median age of 58 years.According to different surgical methods,all patients were divided into the FIGFI-LAH(n=31)and LAH groups(n=39).Preoperative conditions,conversion rate to open surgery,hepatic portal occlusion time,operation time,intraoperative blood loss,postoperative complications,postoperative recurrence and survival were compared between two groups.The positive margin rate was compared by Chi-square test.The survival curve was delineated by Kaplan-Meier method.The 1-,2-and 3-year recurrence and survival rates were compared by Z test.Results In the FIGFI-LAH group,1 case was converted to open surgery,2 cases in the LAH group.The remaining patients successfully completed the surgery.The positive margin rate in the FIGFI-LAH group was 3%(1/31),significantly lower than 21%(8/39)in the LAH group(χ^(2)=4.607,P<0.05).In the FIGFI-LAH group,the 1-,2-,3-year cumulative recurrence rates were 3%,14%,22%,and 5%,17%,72% in the LAH group,respectively.The 3-year cumulative recurrence rate in the FIGFI-LAH group was significantly lower than that in the LAH group(Z=-5.705,P<0.05).The 1-,2-,3-year cumulative survival rates in the FIGFI-LAH group were 100%,100%,84%,and 97%,91% and 53% in the LAH group,respectively.The 3-year cumulative survival rate in the FIGFI-LAH group was significantly higher than that in the LAH group(Z=4.478,P<0.05).Conclusions It is safe and feasible to apply FIGFI in LAH,which can realize visual display of tumor margin and precise hepatectomy,effectively reduce the positive margin rate and contribute to enhancing the long-term survival rate of PLC patients.