穿刺正染ICG荧光导航腹腔镜解剖性肝Ⅶ段切除术1例报告(附视频)

A case report on laparoscopic anatomical liver segment Ⅶ resection with ICG fluorescence-guided puncture positive staining(with video)

背景与目的:腹腔镜解剖性肝切除术已成为肝后叶Ⅶ段(S7)占位性病变的主要手术方式。然而,受限于S7肝蒂复杂解剖结构,在肝表面可有缺血线,而在肝实质内缺乏有效引导。鉴于此,笔者团队采用吲哚菁绿(ICG)荧光穿刺正染技术实施腹腔镜解剖性肝S7切除术。本文对此做一汇报。方法:回顾性分析中国人民解放军陆军军医大学第二附属医院肝胆外科采用ICG荧光穿刺正染技术行腹腔镜解剖性肝S7切除术的1例患者临床资料。结果:按照术前三维重建模拟成功获得肝S7 ICG荧光染色区域后采取足侧入路方式行解剖性肝S7切除,术中循荧光边界及右肝静脉断肝,过程中先后离断S7门静脉(P7)及右肝静脉S7各属支。患者术后恢复良好,术后1个月复查腹部超声见肝S7已切除,未见肿瘤复发征象。结论:ICG荧光穿刺正染技术对腹腔镜解剖性肝S7切除术起到良好的辅助指引作用,可提高手术安全性和保证肿瘤R0切缘。

Background and Aims:Laparoscopic anatomical liver resection has become the main surgical approach for space-occupying lesions located in segmentⅦ(S7)of the posterior lobe of the liver.However,due to the complex anatomical structure of the S7 hepatic pedicle,there may be ischemic lines on the liver surface,but a lack of effective guidance within the liver parenchyma.Given this,our team adopted indocyanine green(ICG)fluorescence-guided puncture positive staining technique for laparoscopic anatomical liver S7 resection.This paper reports on this technique.Methods:The clinical data of one patient who underwent laparoscopic anatomical liver S7 resection using the ICG fluorescence-guided puncture positive staining technique in the Department of Hepatobiliary Surgery,Second Affiliated Hospital of Army Medical University were retrospectively analyzed.Results:Following successful preoperative 3D reconstruction simulation to obtain the ICG fluorescent staining region of liver S7,an anatomical liver S7 resection was performed using a caudal approach.During surgery,the liver was transected along the fluorescent boundary and the right hepatic vein,with sequential division of the S7 portal vein(P7)and tributaries of the right hepatic vein from S7.The patient recovered well after surgery,and one month later,an abdominal ultrasound review showed that liver S7 had been resected with no signs of tumor recurrence.Conclusion:The ICG fluorescence-guided puncture positive staining technique provides excellent assistance in laparoscopic anatomical liver S7 resection,improving surgical safety and ensuring R0 resection margins.