腹腔镜解剖性半肝切除中肝蒂处理与吲哚菁绿剂量影响荧光染色效果的研究

Research on the management of the Glissonean pedicle in laparoscopic anatomical hemihepatectomy and the in⁃fluence of indocyanine green dose on the fluorescence staining effect

目的:探讨腹腔镜解剖性半肝切除术中吲哚菁绿(ICG)荧光染色的方法及剂量选择。方法:采用回顾性横断面研究方法。收集分析2020年10月至2023年10月中国医学科学院肿瘤医院完成的腹腔镜解剖性半肝切除术病人的临床资料,分析肝蒂处理方式、术中ICG荧光染色的方法及效果、ICG注射剂量、术后恢复情况等。结果:共完成腹腔镜解剖性半肝切除术91例,右半肝切除28例,左半肝切除63例。肝蒂处理采用鞘内解剖9例,鞘外解剖82例。ICG荧光染色均采用反染法,其中69例(75.8%)染色成功。肝蒂鞘外解剖、ICG低剂量组较鞘内解剖、ICG高剂量组的染色成功率高。平均手术时间(168.5±32.2)min,术中出血量(152.4±56.3)mL,术中输血6例(6.6%),平均术后住院时间(8.5±2.6)d。中转开腹1例,原因为肿瘤外生性生长压迫肝蒂。4例发生Clavien-DindoⅠ~Ⅱ级并发症,均经治疗后好转。Ⅲa级并发症3例,均为胆漏引起腹腔感染,经穿刺引流治愈。无Ⅲb级以上严重并发症。结论:腹腔镜解剖性半肝切除术ICG荧光染色方法推荐Glisson蒂鞘外解剖的反染法,较低的ICG剂量有助于提高荧光染色成功率。

Objective To investigate the technique and dosage selection of indocyanine green(ICG)fluorescence staining in laparoscopic anatomical hemihepatectomy.Methods A retrospective cross‑sectional study was conducted.The clinical date of the patients who underwent laparoscopic anatomical hemihepatectomy in the Cancer Hospital of the Chinese Academy of Medical Sciences from October 2020 to October 2023 was collected and analyzed,and the management of the Glissonean pedicle,the method and effect of ICG fluorescence staining during the operation,the dose of ICG injection,and the postoperative recovery were analyzed.Results A total of 91 laparoscopic anatomical hemihepatectomies were enrolled in this study,including 28 right hemihepatectomies and 63 left hemihepatectomies.The Glissonean pedicle was dissected intra‑sheath in 9 cases and extra‑sheath in 82 cases.ICG fluorescence staining was all performed using the negative staining method,of which 69 cases(75.8%)were successfully stained.The success rate of staining in the extra‑sheath dissection and low‑dose ICG group was higher than that in the intra‑sheath dissection and high‑dose ICG group.The average operation time was(168.5±32.2)minutes,the intraoperative bleeding volume was(152.4±56.3)ml,and the intraoperative blood transfusion rate was 6.6%(6/91),the average postoperative hospital stay was(8.5±2.6)days.One case was converted to laparotomy due to exophytic growth of the tumor compressing the Glissonean pedicle.Four cases had Clavien‑DindoⅠ‑Ⅱcomplications,all of which improved after treatment.There were 3 cases of gradeⅢa complications,all of which were caused by bile leakage and abdominal cavity infection.They were cured by puncture and drainage.And there were no serious complications above gradeⅢb.Conclusions In laparoscopic anatomical hemihepatectomy,the ICG fluorescence staining method was recommended to use the negative staining method of the extra‑sheath dissection of the Glissonean pedicle,and a lower dose of ICG could help to increase the success rate of fluorescence staining.