吲哚菁绿荧光融合影像技术用于复发性肝癌手术12例分析

Application of fusion indocyanine green fluorescence imaging in the surgical treatment of recurrent hepatocellular carcinoma in 12 cases

目的探讨吲哚菁绿荧光融合影像技术(FIGFI)在复发性肝癌手术治疗中的应用价值。方法回顾性分析南方医科大学珠江医院肝胆一科2015年1月至2018年1月应用FIGFI辅助手术治疗的12例复发性肝癌病人临床资料。采集高质量薄层CT数据进行三维可视化重建、个体化肝分段、术前手术规划。术中使用FIGFI辅助界定肝脏表面肿瘤边界,确定肝切除范围,侦测微小肝癌和转移癌病灶,结合三维可视化图像进行精准肝切除。随访观察术后疗效。结果 12例病人均成功实现三维重建并施行肝切除术,术前CT检查发现12个病灶,而术中FIGFI侦测到15个病灶,新发现的3个病灶中,2个为肝细胞肝癌,1个肝硬化结节。手术时间为267.5(185,345)min,术中出血量287.5(62.5,512.5)mL。术后未发生腹腔出血、腹腔感染、胆漏、肝功能衰竭等严重并发症。围手术期无病例死亡。随访29(3~36)个月,1例失访,4例病人出现转移或复发。所有病人至随诊终点均存活。结论对于复发性肝癌治疗,FIGFI有助于实现解剖性、功能性、根治性肝切除术。

Objective To investigate the application value of fusion indocyanine green fluorescence imaging(FIGFI)in the surgical treatment of recurrent hepatocellular carcinoma.Methods From January 2015 to January 2018,theclinical data of 12 patients with recurrent hepatocellular carcinoma who received surgical treatment guided by three-dimensional visualization technology combined with FIGFI at Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University were analyzed.High-quality thin-slice CT data were collected for three-dimensionalvisualization and reconstruction,individualized liver segmentation and preoperative surgical planning.FIGFI was used todefine the demarcation of tumors,to determine the extent of hepatectomy,and to detect small hepatocellular carcinomaand metastases during the operation.The use of FIGFI in combination with three-dimensional visualization imagesguided the precision hepatectomy.postoperative efficacy was observed by follow-up.Results All the 12 patientsunderwent successful three-dimensional reconstruction and liver resection.Preoperative CT revealed 12 lesions(80%);intraoperative FIGFI detected 15 lesions(100%);of the three newly discovered lesions,2 were hepatocellular carcinomaand 1 was cirrhosis nodule.The operation time was 267.5(183,345)minutes and the amount of bleeding was 287.5(62.5,513.5)m L.No severe complications such as abdominal hemorrhage,abdominal infection,bile leakage and liverfailure occurred postoperatively.No death occurred during the perioperative period.The median follow-up period was 29(3-36)months;during the follow-up period,1 casewas lost and 4 cases had metastasis or recurrence.All the patients were alive at the end of the follow-up.Conclusion FIGFI is helpful to achieveanatomical,functional and radical hepatectomy inthe treatment of recurrent hepatocellular carcinoma.