吲哚菁绿荧光显影在复杂困难肝段肝细胞癌肝切除术的应用研究

Application of indocyanine green fluorescence imaging in hepatectomy of complex and difficult hepatocellular carcinoma

目的探讨吲哚菁绿(ICG)荧光显影在复杂困难肝段肝细胞癌(HCC)肝切除术的应用效果。方法回顾性选择2018年1月至2022年10月行复杂困难肝段切除术的80例HCC患者作为研究对象,按照不同的肿瘤定位及切肝平面确定方案将患者分为常规组和ICG荧光组,每组各40例。常规组:行常规腹腔镜肝切除术(LH);ICG荧光组:于ICG荧光显影指导下完成LH。数据应用软件SPSS 22.0处理。围手术期相关指标、肝功能指标等计量资料采用(x^(-)±s)表示,行独立样本t检验;术后并发症等计数资料采用[例(%)]表示,行χ^(2)检验。P<0.05为差异有统计学意义。结果ICG荧光组患者手术时间、术中出血量、肝门阻断时间及术后住院时间显著低于常规组,R0切缘率显著高于常规组,差异均有统计学意义(P<0.05);两组患者术后肛门排气时间、术后拔管时间、术后并发症总发生率比较,差异无统计学意义(P>0.05)。时间与方法在ALB、TBIL、AST、ALT水平上不存在交互作用(P>0.05),时间与方法在ALB、TBIL、AST、ALT水平上主效应显著(P<0.05)。结论ICG荧光显影在复杂困难肝段肝细胞癌肝切除术中的应用是安全、有效的,其不仅能够有效缩短手术时间和肝门阻断时间,减少术中损伤,提高R0切除率,还有利于患者术后恢复和肝功能的恢复,值得临床广泛推广应用。

Objective To investigate the efficacy of indocyanine green(ICG)fluorescence imaging in hepatectomy of complex and difficult hepatocellular carcinoma(HCC).Methods A total of 80 HCC patients who underwent complex and difficult hepatectomy from January 2018 to October 2022 were retrospectively selected as subjects.According to different tumor localization and hepatectomy plane determination scheme,the patients were divided into conventional group and ICG fluorescence group,with 40 cases in each group.Conventional group:Routine laparoscopic hepatectomy(LH);ICG fluorescence group:LH was completed under the guidance of ICG fluorescence development.Data was processed by SPSS 22.0.Perioperative relevant indicators,liver function indicators and other measurement data were represented by(x^(-)±s),independent t test;Statistical data such as postoperative complications were represented by[cases(%)],χ^(2) test was performed.P<0.05 was considered statistically significant.Results Operation time,intraoperative blood loss,hilar occlusion time and postoperative hospital stay in ICG fluorescence group were significantly lower than those in conventional group,and R0 margin rate was significantly higher than that in conventional group,with statistical significance(P<0.05).There was no significant difference in postoperative anal exhaust time,postoperative extubation time and postoperative complication incidence between the two groups(P>0.05).There was no interaction between time and method at the levels of ALB,TBIL,AST and ALT(P>0.05),while the main effect of time and method was significant at the levels of ALB,TBIL,AST and ALT(P<0.05).Conclusion The application of ICG fluorescence imaging in hepatectomy of complex and difficult hepatocellular carcinoma is safe and effective.It can not only effectively shorten the operation time and hilar occlusion time,reduce intraoperative injury and improve R0 resection rate,but also benefit the postoperative recovery of patients and the recovery of liver function,which is worthy of widespread clinical application.