经支气管镜注射吲哚菁绿在婴幼儿胸腔镜肺段切除术中的应用

Transbronchoscopic injection of indocyanine green during thoracoscopic anatomical pulmonary segmentectomy in infants

目的探讨经支气管镜注射吲哚菁绿用于婴幼儿胸腔镜解剖性肺段切除术中判断段间平面的可行性和安全性。方法纳入2021年1月至2022年6月于西安交通大学第二附属医院小儿外科接受经支气管镜注射吲哚菁绿及胸腔镜解剖性肺段切除术的婴幼儿82例的临床资料, 其中男47例, 女35例;中位年龄为7(6, 11)个月, 年龄范围为3~34个月, 体重为(9.32±2.40)kg, 身高为(74.41±10.22)cm。依据胸部CT设计手术和经支气管镜注射吲哚菁绿的方案。全身麻醉成功后按计划经支气管镜将吲哚菁绿溶液注射入靶段支气管。应用荧光胸腔镜观察靶段肺组织的荧光效应, 判定段间平面。观察染色成功率、并发症、靶段切除准确率情况。结果所有患儿均按计划完成手术, 其中76例经支气管镜注射吲哚菁绿后可清晰准确地显示段间平面, 染色成功率为92.7%(76/82), 术中均无并发症发生。术后即刻行支气管镜检查, 靶段切除准确率为100%。术后6个月复查CT均未见病灶残留或复发。结论在婴幼儿胸腔镜解剖性肺段切除术中, 经支气管镜注射吲哚菁绿是一种安全、准确的识别段间平面的方法。

ObjectiveTo explore the feasibility and safety of transbronchoscopic injection of indocyanine green(ICG)for identifying intersegmental plane during thoracoscopic anatomical pulmonary segmentectomy in infants.MethodsA total of 82 infants undergoing thoracoscopic anatomical pulmonary segmentectomy were recruited into this retrospective study.There were 47 boys and 35 girls with a median age 7(3-34)months,a median weight(9.32±2.40)kg and a median height(74.41±10.22)cm.Surgical planning was formulated according to preoperative chest computed tomography(CT,0.5 mm).After successful general anesthesia,ICG was injected into target segment bronchus via bronchoscopy.During operation,near infrared(NIR)thoracoscope was utilized for detecting ICG fluorescence and determining intersegmental plane.The success rate of staining,complications and accuracy of target segment resection were recorded.ResultsAll infants completed surgery as planned.And 76/82(92.7%)could distinctly and accurately display intersegmental plane after ICG staining.No intraoperative complications occurred.Routine CT examination at Month 6 revealed no residual lesion or recurrence.ConclusionA transbronchoscopic injection of ICG for identifying intersegmental plane is both safe and feasible during NIR-guided thoracoscopic anatomical pulmonary segmentectomy in infants.