ICG荧光导航的腹腔镜肝切除术临床意义

Clinical significance of ICG fluorescence guided laparoscopic hepatectomy

目的探索在原发性肝癌(PLC)患者行腹腔镜肝切除术过程中联合使用吲哚菁绿荧光(ICG)显像技术的效果。方法回顾性分析2021年10月至2023年10月收治的78例PLC患者病例资料,按照不同治疗方法将其分为对照组(n=38,腹腔镜肝切除术治疗)和联合组(n=40,ICG+腹腔镜肝切除术治疗);采用SPSS 26.0的统计学软件,肝肾功能、炎症因子、应激指标等计量资料采用独立t检验方法;疗效采用秩和检验;术后并发症等计数资料的比较用χ^(2)检验。P<0.05为差异有统计学意义。结果两组患者术前(T0)肝功能各项指标水平差异均无统计学意义(P>0.05);术后1d(T1)时,两组患者谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)比T0升高,血清白蛋白(ALB)比T0低(P<0.05);术后1个月(T30),两组患者血清白蛋白有所升高,但仍低于T0(P<0.05),而ALT、AST、TBIL基本恢复至T0水平(P<0.05)。T30时,联合组客观缓解率(ORR)、疾病控制率(DCR)差异均无统计学意义(P>0.05),但术后3个月,联合组ORR、DCR分别90.0%、92.5%,均高于对照组的65.8%、76.3%(P<0.05)。T1时,两组患者白细胞介素-6(IL-6)、C反应蛋白(CRP)和肿瘤坏死因子-α(TNF-α)及皮质醇(Cor)、肾上腺素(E)均比T0升高(P<0.05),但联合组低于对照组(P<0.05);与T1比,T30时,两组患者IL-6、CRP、TNF-α、Cor及E均降低(P<0.05),且基本恢复至T0水平(P<0.05)。与对照组比,联合组胆瘘、渗血、包裹性积液所致发热总发生率较低(P<0.05)。结论ICG荧光显像技术联合腹腔镜肝切除术治疗PLC安全、有效,在炎症因子、应激指标方面均有较好的改善作用。

Objective To explore the effect of indocyanine green fluorescence(ICG)imaging in combination with laparoscopic hepatectomy in patients with primary liver cancer(PLC).Methods Data of 78 PLC patients admitted from October 2021 to October 2023 were retrospectively analyzed,and divided into control group(n=38,laparoscopic hepatectomy)and combination group(n=40,ICG+laparoscopic hepatectomy)according to different treatment methods.The statistical software SPSS 26.0 was used,and the measurement data of liver and kidney function,inflammatory factors and stress indexes were measured by independent t test.The curative effect was tested by rank sum test.The statistical data of postoperative complications were compared byχ^(2)test.P<0.05 was considered statistically significant.Results There was no statistical significance in preoperative(T0)liver function between 2 groups(P>0.05).At 1 day(T1)after surgery,alanine aminotransferase(ALT),aspartate aminotransferase(AST)and total bilirubin(TBIL)in 2 groups were higher than T0,and serum albumin(ALB)was lower than T0(P<0.05).One month after surgery(T30),serum albumin in both groups was increased,but still lower than T0(P<0.05),while ALT,AST and TBIL basically recovered to T0 levels(P<0.05).At T30,the objective response rate(ORR)and disease control rate(DCR)of the combined group had no statistical significance(P>0.05),but at 3 months after surgery,the ORR and DCR of the combined group were 90.0%and 92.5%,respectively,which were higher than 65.8%and 76.3%of the control group(P<0.05).At T1,interleukin-6(IL-6),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),cortisol(Cor)and epinephrine(E)in 2 groups were increased compared with T0(P<0.05),but the combined group was lower than the control group(P<0.05).Compared with T1,at T30,IL-6,CRP,TNF-α,Cor and E in both groups were decreased(P<0.05),and basically recovered to T0 level(P<0.05).Compared with control group,the total incidence of fever caused by bile leakage,blood seepage and encapsulated effusion was lower in combination group(P<0.05).Conclusion ICG fluorescence imaging combined with laparoscopic hepatectomy in the treatment of PLC is safe and effective,and has a good improvement in inflammatory factors and stress indexes.