吲哚菁绿荧光显影在腹腔镜子宫内膜异位症病灶切除术中的应用

Application of indocyanine green fluorescence imaging in laparoscopic lesion resection of endometriosis

目的探讨吲哚菁绿(indocyanine green,ICG)荧光显影在腹腔镜子宫内膜异位症(endo-metriosis,EMs)病灶切除术中的应用价值。方法选择2020年1月至2022年6月手术治疗的76例EMs患者作为研究对象,按随机数字表分为两组,对照组(n=38)行常规腹腔镜异位病灶切除术,观察组(n=38)行腹腔镜病灶切除术中采用ICG荧光显影技术。观察ICG显影情况,比较两组患者手术相关指标,术后第6月、12月疼痛视觉模拟评分(visual analogy scale,VAS)及复发率。结果观察组静脉注射ICG后平均显影时间为(45.37±7.52)s;18例腹膜型与1例腹壁型异位灶均显影(100%),14例卵巢型中显影5例(35.71%),5例深部浸润型中显影4例(80%)。两组患者手术时间、术中出血量、术后首次肛门排气时间及并发症发生率比较均无统计学差异(P>0.05)。观察组术中切除病灶数及切除病灶阳性数均多于对照组,病灶切缘阴性率高于对照组,术后第6月与12月VAS评分及复发率低于对照组,差异均有统计学意义(P均<0.05)。结论腹腔镜EMs病灶切除术中应用ICG荧光显影有助于精准定位病灶,提高病灶彻底切除率,降低术后复发率。

Objective To investigate the application value of indocyanine green(ICG)fluorescence imaging in laparoscopic focus resection of endometriosis(EMs).Methods A total of 76 EMs cases admitted in our hospital from January 2020 to June 2022 were selected and divided into two groups according to random number table method,with 38 cases in each group.Routine laparoscopic focus resection was performed in the control group,and laparoscopic focus resection with ICG fluorescence imaging was performed in the observation group.The ICG fluorescence visualization was recorded in the observation group,and the peri-operative indicators,VAS scores and recurrence rate of 6th and 12th month after the surgery were compared between the two groups.Results The average imaging time of ICG was(45.37±7.52)s after intravenous injection.Ectopic lesions were vis-ualized in 18 cases(18/18)with peritoneal endometriosis,1 case(1/1)with abdominal wall endometriosis(AWE),5 cases(5/14)with ovarian endometriosis and 4 cases(4/5)with deep infiltrating endometriosis(DIE).There was no significant difference in operation time,intra-operative blood loss,first anal exhaust time after the surgery and incidence of complications between the two groups(P>0.05).Compared to the control group,the numbers of resected lesions and positive lesions and the negative rate of lesion margin were higher,and VAS scores and recurrence incidence of 6th and 12th month after the surgery were lower in the observation group,and all the differences were significant(P<0.05).Conclusion The technique of ICG fluorescence imaging can locate the lesion accurately,improve the complete resection rate of lesion effectively,and reduce post-opera-tive recurrence incidence significantly in laparoscopic EMs lesion resection.