ICG荧光染色在肝癌腹腔镜解剖性肝切除术中的应用

Application of ICG fluorescence staining in laparoscopic anatomical hepatectomy for primary liver cancer

目的探讨ICG荧光染色在原发性肝癌(肝癌)腹腔镜解剖性肝切除术中应用的可行性和安全性。方法回顾性分析2021年1月至2021年12月解放军总医院第五医学中心行腹腔镜解剖性肝切除术的52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40例,女12例;平均年龄(56±9)岁。中国肝癌分期(CNLC)Ⅰa期34例,Ⅰb期13例,Ⅱa期5例;肿瘤直径中位数3.1(1.1~13.2)cm。术前行三维可视化重建评估,术中超声引导下行ICG荧光染色。观察术中ICG染色情况、手术和术后情况、随访情况。结果所有患者均顺利完成手术。52例患者中45例染色成功,7例失败;其中采用反染法32例,染色失败2例,成功率94%;采用正染法20例,染色失败5例,成功率75%。手术方式包括腹腔镜右半肝切除术5例,左半肝切除术4例,右前叶切除术7例,右后叶切除术2例,肝中叶切除术2例,Ⅴ段切除术11例,Ⅵ段切除术1例,Ⅶ段切除术11例,Ⅷ段切除术9例。手术时间279(88~447)min,术中出血量200(50~500)ml。术后住院时间(9.1±3.5)d。术后出现并发症3例,其中胆漏1例,经引流后痊愈;胸腔积液1例,经胸腔穿刺引流后痊愈;肺部感染1例,予抗感染治疗后痊愈。术后未发生出血等并发症,无术后死亡。术后随访期间2例肝内复发。结论ICG荧光染色应用于腹腔镜解剖性肝切除术中安全可行。反染法成功率高,正染法尤其适用于后、上肝段等困难部位的解剖性肝段切除。

Objective To evaluate the feasibility and safety of ICG fluorescence staining in laparoscopic anatomical hepatectomy for primary liver cancer(PLC).Methods Clinical data of 52 PLC patients who underwent laparoscopic anatomical hepatectomy in the Fifth Medical Center of Chinese PLA General Hospital from January to December 2021 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,40 patients were male and 12 female,aged(56±9)years on average.According to China Liver Cancer Staging(CNLC)System,34 cases were classified as stageⅠa,13 cases of stageⅠb and 5 cases of stageⅡa,respectively.The median tumor diameter was 3.1(1.1-13.2)cm.Three-dimensional visualization reconstruction and evaluation were performed before operation.Intraoperative ultrasound-guided ICG fluorescence staining was carried out.Intraoperative ICG staining,intraoperative and postoperative conditions,and postoperative follow-up were observed.Results All patients successfully completed the operation.Of 52 patients,ICG staining were performed successfully in 45 cases and failed in 7 cases.32 patients were subject to reverse staining,and2 cases failed with a success rate of 94%.20 cases received positive staining and 5 cases failed,with a success rate of 75%.Surgical methods included laparoscopic right hepatectomy in 5 cases,left liver resection in4 cases,right anterior lobectomy in 7 cases,right posterior lobectomy in 2 cases,middle lobe resection in2 cases,segmentⅤresection in 11 cases,segmentⅥresection in 1 case,segmentⅦresection in 11 cases and segmentⅧresection in 9 cases,respectively.The operation time was 279(88-447)min,and intraoperative blood loss was 200(50-500)ml.The length of postoperative hospital stay was(9.1±3.5)d.Postoperative complications occurred in 3 patients,including 1 case of bile leakage,which was treated after drainage,1 case of pleural effusion,which was cured by thoracic puncture and drainage,and 1 case of pulmonary infection,which was healed after anti-infection treatment.No bleeding,other postoperative complications or death was observed.During postoperative follow-up,2 cases developed intrahepatic recurrence.Conclusions It is safe and feasible to perform ICG fluorescence staining in laparoscopic anatomical hepatectomy.The success rate of reverse staining is high.Positive staining is especially suitable for anatomical hepatectomy of difficult segments,such as posterior and upper hepatic segments.