实时虚拟超声术中导航联合吲哚菁绿荧光显像技术在解剖性肝段切除手术中的应用研究

Application of real-time virtual sonography surgical navigation combined with indocyanine green fluorescence imaging technology during anatomical liver resection

目的分析实时虚拟超声(RVS)术中导航联合吲哚菁绿荧光显像技术在肝细胞癌解剖性肝段切除手术中的应用效果。方法回顾性分析2020年1月至2022年1月在北京大学国际医院肝胆外科采用RVS术中导航联合吲哚菁绿荧光显像技术行解剖性肝段切除的35例肝细胞癌患者临床资料,其中男性22例,女性13例,年龄(60.0±10.0)岁。RVS将术中超声和相应的术前CT或MRI图像融合,通过融合后的图像指导手术平面。分析手术方式、手术时间、术中出血量、手术切缘、住院时间,术后并发症采用Clavien-Dindo系统分级。通过门诊复查或打电话随访患者术后1年生存和无瘤生存情况。结果35例患者解剖性切除肝Ⅱ段1例(2.9%)、Ⅲ段1例(2.9%)、Ⅳ段5例(14.3%)、Ⅴ段6例(17.1%)、Ⅵ段10例(28.6%)、Ⅶ段7例(20.0%)、Ⅷ段4例(11.4%),Ⅴ+Ⅷ段1例(2.9%)。35例患者手术时间(310.2±81.6)min,术中出血量[M((Q_(1),Q_(3))][390.0(250.0,500.0)]ml,住院时间(11.6±2.1)d。围手术期无死亡。3例(8.6%)出现术后并发症,其中2例(5.7%)均为腹水,Clavien-Dindo分级Ⅰ级;1例(2.9%)术后出血,Clavien-Dindo分级Ⅱ级。术后病理检查均为肝细胞癌,手术切缘均为阴性。35例患者随访12~20个月,中位随访时间为14个月。术后1年总体生存率为100.0%(35/35),有3例(8.6%)术后肿瘤复发,术后1年无瘤生存率为91.4%(32/35)。结论RVS术中导航联合吲哚菁绿荧光显像技术指导肝细胞癌解剖性肝段切除手术安全、可行。

Objective To analyze the clinical effect of real-time virtual sonography(RVS)surgical navigation combined with indocyanine green fluorescence imaging technology in the anatomical liver segmentectomy for hepatocellular carcinoma(HCC).Methods The clinical data of 35 patients who underwent anatomical liver segmentectomy using RVS surgical navigation combined with indocyanine green fluorescence imaging technology in the Department of Hepatobiliary Surgery of Peking University International Hospital from January 2020 to January 2022 were retrospectively analyzed.There were 22 males and 13 females,aged(60.0±10.0)years.RVS is real-time virtual sonography,which fuses real-time intraoperative ultrasound images with corresponding preoperative CT or MRI images to guide the surgical plane.Methods of operation,time of operation,intraoperative blood loss,operative margin,hospital stay and postoperative complications were analyzed.Postoperative complications were graded by Clavien-Dindo system.The 1-year overall survival and tumor-free survival rates of patients were followed up by outpatient or telephone review.Results Anatomical liver segmentectomy was performed on 36 patients,including 1 patient(2.9%)of segmentⅡ,1 patient(2.9%)of segmentⅢ,5 patients(14.3%)of segmentⅣ,6 patients(17.1%)of segmentⅤ,10 patients(28.6%)of segmentⅥ,7 patients(20.0%)of segmentⅦ,4 patients(11.4%)of segmentⅧ,and 1 patient(2.9%)of segmentsⅤ+Ⅷ.The operation time of 35 patients was(310.2±81.6)min,with an intraoperative blood loss of[M((Q_(1),Q_(3))]390.0(250.0,500.0)ml.The hospital stay was(11.6±2.1)d.There was no postoperative death.Postoperative complications occurred in 3 cases(8.6%),of which 2 cases(5.7%)were ascites,Clavien-Dindo gradeⅠ;Postoperative hemorrhage occurred in 1 case(2.9%),Clavien-Dindo gradeⅡ.HCC was confirmed by pathology in all cases,and the operative margins were negative.The median follow-up time was 14 months(12 to 20 months).The 1-year overall survival rate after surgery was 100.0%(35/35),three patients(8.6%)had tumor recurrence,and the 1-year tumor-free survival rate was 91.4%(32/35).Conclusion RVS surgical navigation combined with indocyanine green fluorescence imaging technology could be feasible in anatomical segmental hepatectomy for HCC.