吲哚菁绿荧光融合影像引导下背头尾侧联合入路腹腔镜解剖性左半肝切除术的临床应用

Application of indocyanine green fluorescence fusion image guided laparoscopic anatomical left hemihepatectomy through the combined dorsal head and caudal approach

目的探索吲哚菁绿(ICG)荧光融合影像引导下背头尾侧联合入路腹腔镜解剖性左半肝切除术的可行性及安全性,寻找一种流程化及标准化的手术方式。方法回顾性选择2019年5月至2022年8月间在九江学院附属医院行腹腔镜左半肝切除术患者42例作为研究对象,根据手术入路不同分为对照组(21例,尾侧入路)和试验组(21例,ICG荧光融合影像引导下背头尾侧联合入路)。比较两组患者手术时间、术中出血量、术中肝中静脉显露率、术后1 d肝功能情况[谷丙转氨酶(ALT)和天门冬氨酸氨基转移酶(AST)],以及住院总时间、术后并发症发生率的差异。结果与对照组比较,试验组手术时间更短[(60.14±9.12)min vs(61.05±10.38)min,t=-3.096,P=0.004],术中出血量更少[(199.05±98.13)mL vs(280.48±118.05)m L,t=-2.431,P=0.02],术中肝中静脉显露率更高(95.2%vs 23.8%,χ^(2)=22.24,P=0.001),更符合解剖性肝切除理念;而且,试验组总住院时间更短[(12.05±3.02)d vs(15.52±4.51)d,t=-2.92,P=0.006],术后第1天转氨酶水平更低[ALT(227.24±113.87)U/L vs(369.29±234.80)U/L,t-=2.49,P=0.02;AST(235.62±104.65)U/L vs(370.71±260.25)U/L,t=-2.21,P=0.04],差异均具有统计学意义(P<0.05)。两组术后并发症发生率比较差异无统计学意义(P>0.05)。结论ICG荧光融合影像引导下背头尾侧联合入路腹腔镜解剖性左半肝切除术是一种安全可行的手术治疗方式。

Objective To explore the feasibility and safety of indocyanine green(ICG)fluorescence fusion image guided laparoscopic anatomical left hemihepatectomy through the combined dorsal head and caudal approach,and to explore a procedural and standardized surgical method.Methods A total of 42 patients,who underwent laparoscopic left hemihepatectomy in the Affiliated Hospital of Jiujiang University from May 2019 to Aug.2022,were selected as the study subjects.According to different surgical approaches,patients were divided into control group(with caudal approach,n=21)and experimental group(with combined dorsal head and caudal approach,guided by ICG fluorescence fusion imaging,n=21).The operation time,intraoperative blood loss,intraoperative exposure rate of middle hepatic vein,hospitalization time,liver function including alanine transaminase(ALT)and aspartate transaminase on the 1st day postoperative,and postoperative complications were compared between the two groups.Results Compared with the control group,the experimental group had shorter operation time[(60.14±9.12)min vs(61.05±10.38)min,t=-3.096,P=0.004],less intraoperative bleeding[(199.05±98.13)mL vs(280.48±118.05)mL,t=-2.431,P=0.02],and higher intraoperative exposure rate of hepatic veins(95.2%vs 23.8%,χ^(2)=22.24,P=0.001),which was more in line with the concept of anatomical liver resection.Moreover,the total hospitalization time in the experimental group was shorter[(12.05±3.02)d vs(15.52±4.51)d,t=-2.92,P=0.006],the levels of transaminases were lower on the 1st day postoperative[ALT(227.24±113.87)U/L vs(369.29±234.80)U/L,t=-2.49,P=0.02;AST(235.62±104.65)U/L vs(370.71±260.25)U/L,t=-2.21,P=0.04].There was no statistically significant difference in the incidence rate of postoperative complications between the two groups(P>0.05).Conclusion For laparoscopic anatomical left hemihepatectomy,with the guide of ICG fluorescence fusion image,and with the combined dorsal head and caudal approach,which is safe and feasible.