优先阻断靶段肺静脉吲哚菁绿荧光识别段间平面在胸腔镜肺段切除术中的应用

Indocyanine green fluorescence identification of the intersegmental plane by preferentially ligating the target pulmonary vein during thoracoscopic segmentectomy

目的创新性尝试在胸腔镜肺段切除中阻断靶段肺静脉后应用吲哚菁绿荧光识别段间平面,并评估其可行性和准确性。方法回顾性分析2022年12月—2023年6月在南京市胸科医院胸外科同一医疗组采用靶段静脉阻断后应用吲哚菁绿荧光显示段间平面行胸腔镜解剖性肺段切除术肺结节患者的临床资料。术前三维重建辨识肺结节所在靶段及靶段动静脉、支气管的解剖结构;术中结扎靶段静脉后即通过膨胀-萎陷法确定段间平面,等待期间可进行靶段动脉和支气管的分离但不切断,出现膨胀-萎陷界线电凝烧灼标记后经外周静脉注射吲哚菁绿荧光法对段间平面再次识别,最终评估两个段间平面的一致性。结果纳入32例患者,其中男14例、女18例,年龄25~76(58.69±11.84)岁。所有患者靶段静脉阻断后均成功观察到膨胀-萎陷段间平面与吲哚菁绿荧光确定的段间平面基本一致,两个段间平面高度吻合。32例患者均顺利完成单孔胸腔镜肺段切除术,无吲哚菁绿相关并发症,无围术期死亡病例,平均肺段手术时间(98.59±20.72)min,平均术中出血量(45.31±35.65)mL,平均术后胸腔引流管留置时间(3.50±1.16)d,平均术后住院时间(4.66±1.29)d,平均肿瘤切缘宽度(26.96±5.86)mm。结论阻断靶段肺静脉后吲哚菁绿荧光可安全、准确识别段间平面,是简化胸腔镜解剖性肺段切除技术的有益探索和重要补充。

Objective To explore the feasibility and accuracy of using indocyanine green fluorescence(ICGF)to identify the intersegmental plane after ligation of the target pulmonary vein during thoracoscopic segmentectomy.Methods From December 2022 to June 2023,the patients with pulmonary nodules undergoing video-assisted thoracoscopic anatomical segmentectomy with intersegmental plane displayed using ICGF after ligation of the target pulmonary vein by the same medical team in our hospital were collected.Preoperative three-dimensional reconstruction was used to identify the target segment where the pulmonary nodule was located and the anatomical structure of the arteries,veins,and bronchi in the target segment.The intersegmental plane was first determined by the inflation-deflation method after the target pulmonary vein was ligated during the operation.During the waiting period,the target artery and bronchus could be separated but not cut off.The inflation-deflation boundary was marked by electrocoagulation,and then ICGF was injected via peripheral vein to identify the intersegmental plane again,and the consistency of the two intersegmental planes was finally evaluated.Results Finally 32 patients were collected,including 14 males and 18 females,with an average age of 58.69±11.84 years,ranging from 25 to 76 years.The intersegmental plane determined by inflation-deflation method was basically consistent with ICGF method in all patients.All the 32 patients successfully completed uniportal thoracoscopic segmentectomy without ICGF-related complications or perioperative death.The average operation time was 98.59±20.72 min,the average intraoperative blood loss was 45.31±35.65 mL,and the average postoperative chest tube duration was 3.50±1.16 days.The average postoperative hospital stay was 4.66±1.29 days,and the average tumor margin width was 26.96±5.86 mm.Conclusion The ICGF can safely and accurately identify the intersegmental plane by target pulmonary venous preferential ligation in thoracoscopic segmentectomy,which is a useful exploration and important supplement to the simplified thoracoscopic anatomical segmentectomy.