近红外荧光成像在泌尿系统手术中的研究进展

Research Progress of Near-Infrared Fluorescence Imaging in Urological Surgery

逾一个世纪以来,外科医生主要靠依靠视觉反馈和临床经验来执行手术操作。然而,术者对手术区域的准确判断对患者手术预后及后续随访治疗计划的制定至关重要。随着成像技术的不断进步,计算机断层扫描、核磁共振成像、超声波检查以及X射线等影像学检查日益频繁地被应用于外科手术中,图像引导下的手术在提供术中导航和辅助决策方面发挥着关键作用。尽管如此,这些传统的影像学检查手段在实际应用中仍存在一些局限性,包括放射性X射线或核素辐射的暴露、对带有体内金属植入物患者的使用禁忌、对患者体位的特定要求,以及术中伪影导致图像分辨率降低等可能。上述问题不仅使外科医生和患者的健康风险增加,亦可能引起手术过程中的导航误差,导致健康组织遭到过度切除、病变组织未能被彻底清除或遗漏术中受到损伤的组织器官,进而影响手术疗效的彻底性。具有诸多优势的光学成像技术有望为改善上述问题带来希望。其中,近红外窗口又是目前该领域更为先进及具有热点的成像波段。因此本文将对NIR成像在泌尿系手术中的应用作出综述。

For more than a century, surgeons have relied on visual feedback and clinical experience to perform surgical operations. However, accurate judgment of the surgical area by the operator is critical to the patient’s surgical prognosis and subsequent follow-up treatment planning. With advances in imaging technology, imaging examinations such as computed tomography, magnetic resonance imaging, ultrasonography, and X-rays are being used with increasing frequency in surgery, and image-guided surgery plays a key role in providing intraoperative navigation and aiding decision making. Nonetheless, there are several limitations to the practical application of these traditional imaging modalities, including exposure to radioactive X-ray or nuclide radiation, contraindications to the use of patients with metallic implants in the body, specific requirements for patient positioning, and the possibility of intraoperative artifacts that result in reduced image resolution. These problems not only increase the health risks for surgeons and patients, but also cause navigational errors during surgery, which may lead to over-excision of healthy tissues, incomplete removal of diseased tissues, or omission of tissues or organs that have been damaged during surgery, thus affecting the thoroughness of the surgical outcome. Optical imaging technology with many advantages is expected to bring hope to improve the above problems. Among them, the near-infrared window is currently the more advanced and hot imaging band in this field. Therefore, this paper will give an overview of the application of NIR imaging in urologic surgery.