ICG荧光显影Laennec膜入路腹腔镜解剖性肝切除的临床研究

Clinical study of laparoscopic anatomic hepatectomy by laennec membrane approach with ICG fluorescence imaging

目的:探究ICG荧光显影技术在laennec膜入路腹腔镜解剖性肝切除术(LALR)中的应用效果。方法:回顾性分析2019年6月至2022年12月74例肝细胞癌患者资料,所有患者均行Laennec膜入路LALR,根据手术是否应用ICG分为ICG组(n=39)和非ICG组(n=35)。采用SPSS 24.0分析数据。两组患者围手术期指标、肝功能指标等计量资料用(x±s)表示,采用独立样本t检验;术后并发症等计数资料用[n(%)]表示,采用χ^(2)检验;生存分析采用Kaplan-Meier法并行Log-Rank检验。P<0.05为差异有统计学意义。结果:ICG组患者手术时间、肝门阻断时间、拔除引流管时间、术后住院时间显著短于非ICG组,切缘距离长于非ICG组,术中出血量少于非ICG组(P<0.05);两组患者术后3d时谷丙转氨酶(ALT)、谷草转氨酶(AST)、血清白蛋白(ALB)水平较术前显著升高,且非ICG组显著高于ICG组(P<0.05);两组患者术后并发症总发生率(10.4%vs.14.3%)、两组患者累积无病生存率(DFS)、总生存率(OS)比较(74.4%vs.68.6%,79.5%vs.71.4%),差异均无统计学意义(P>0.05)。结论:在laennec膜入路LALR中应用ICG荧光显影技术可精确定位肿瘤位置并在肝实质内实时追踪、确定切肝界面,更利于指导手术精确切除,最大限度保护正常肝实质,缩短术中肝门阻断时间和手术时间,减少术中出血量,促进患者术后肝功能恢复。

Objective:To investigate the efficacy of ICG fluorescence imaging in laparoscopic anatomic hepatectomy by laennec membrane approach.Methods:74 patients with hepatocellular carcinoma admitted to our hospital from June 2019 to December 2022 were retrospectively selected as study subjects.All patients underwent laennec membrane approach laparoscopic anatomic hepatectomy,and were divided into ICG group(n=39)and non-ICG group(n=35)according to whether ICG was used in surgery.SPSS 24.0 was used to analyze the data.Perioperative indexes,liver function indexes and other measurement data of the two groups were expressed with(x±s),and independent sample t test was used.The statistical data of postoperative complications were expressed by[n(%)]andχ^(2) test was used.Kaplan-Meier method and Log-Rank test were used for survival analysis.P<0.05 was considered statistically significant.Results:The operation time,hilar occlusion time,drainage tube removal time and postoperative hospitalization time in ICG group were significantly shorter than those in non-ICG group,the incision margin distance was longer than that in non-ICG group,and the intraoperative blood loss was less than that in non-ICG group(P<0.05).The levels of ALT,AST and ALB in both groups were significantly higher than those before surgery,and the non-ICG group was significantly higher than the ICG group(P<0.05).There was no significant difference in the total incidence of postoperative complications between the two groups(10.4%vs 14.3%).Cumulative DFS and OS were compared between the two groups(74.4%vs.68.6%,79.5%vs.71.4%),and there was no statistical significance(P>0.05).Conclusion:The application of ICG fluorescence imaging technology in laennec membrane approach laparoscopic anatomic hepatectomy can accurately locate the tumor location and track and determine the hepatectomy interface in real time within the hepatic parenchyma,which is more conducive to guiding the accurate surgical resection,protecting the normal hepatic parenchyma to the maximum extent,shortening the intraoperative portal blocking time and operation time,reducing intraoperative blood loss,and promoting the postoperative liver function recovery of patients.