ICG荧光实时成像技术在特殊部位肝癌腹腔镜肝切除中的安全性及有效性观察
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摘要
目的分析腹腔镜下吲哚菁绿(ICG)荧光实时成像联合腹腔镜数字超声引导技术在特殊部位肝癌腹腔镜肝切除中的安全性及有效性。方法选择2016年1月-2017年12月解放军总医院肝胆外科诊断为特殊位置肝脏恶性肿瘤患者24例,其中ICG荧光组(n=12)术前静脉注射ICG,采用荧光腹腔镜进行肝脏切除术,以12例行普通腹腔镜切除者(普通腹腔镜组)为对照。对两组患者的手术时间、术中出血量、并发症、住院时间等术中及术后指标进行分析,并判断腹腔镜ICG荧光实时成像联合数字超声引导技术的临床可行性。结果 ICG荧光组患者1例中转开腹、1例行腹腔镜下射频消融术,其余均完整切除病灶;普通腹腔镜组1例中转开腹,其余11例完成腹腔镜根治性切除。两组患者手术时间差异无统计学意义[(215.0±35.8)min vs.(208.0±18.6)min,P=0.554]。与普通腹腔镜组比较,ICG荧光组术中出血量明显减少[(255.0±19.4)ml vs.(230.0±17.5)ml,P=0.0032],住院时间明显缩短[(8.9±1.2)d vs.(10.6±1.6)d,P=0.0076]。两组患者在手术R0切缘、并发症方面差异无统计学意义(P=0.308;P=0.173)。结论腹腔镜ICG荧光实时成像联合数字超声引导技术在特殊部位肝癌的肝切除中安全、有效,值得临床进一步推广。
Objective To analyze the safety and efficacy of indocyanine green(ICG) fluorescence real-time imaging technology and digital ultrasound guidance technology for laparoscopic liver resection(LLR) of HCC at special location. Methods Twenty-four patients with hepatocellular carcinoma at special location were enrolled and equally divided into two groups: ICG fluorescent group received intravenous indocyanine green injection 2-3 days before operation, and then did fluorescent laparoscopic liver resection, while the normal control group were given general laparoscopic liver resection; meanwhile, the intraoperative and postoperative indexes including operative time, intraoperative bleeding, complications and length of hospital stay were analyzed to judge the clinical feasibility. Results Except 1 case treated with laparoscopic radiofrequency ablation because of the old age and illness factors and 1 case for conversion to laparotomy, all the rest were treated by LLR with ICG real-time images combined guidance of ultrasound in ICG fluorescent group, and all the patients but one who underwent conversion to laparotomy received general laparoscopic resection in the normal control group. There was no statistical difference between the two groups in terms of operative time [(215.0±35.8)min vs.(208.0±18.6)min, P=0.554]. As compared with the normal control group, the intraoperative bleeding volume significantly reduced [(255.0±19.4)ml vs.(230.0±17.5)ml, P=0.0032], and the hospital stay significantly shortened [(8.9±1.2)d vs.(10.6±1.6)d, P=0.0076], but there was no statistical differences between the two groups in R0 cutting edge and complications(P=0.308; P=0.173). Conclusion Laparoscopic liver resection using ICG fluorescence real-time imaging combined the digital imaging technology under ultrasound guidance is a safe and effective treatment approach for HCC at the special position, being worthy of further promotion clinically.
Objective To analyze the safety and efficacy of indocyanine green(ICG) fluorescence real-time imaging technology and digital ultrasound guidance technology for laparoscopic liver resection(LLR) of HCC at special location. Methods Twenty-four patients with hepatocellular carcinoma at special location were enrolled and equally divided into two groups: ICG fluorescent group received intravenous indocyanine green injection 2-3 days before operation, and then did fluorescent laparoscopic liver resection, while the normal control group were given general laparoscopic liver resection; meanwhile, the intraoperative and postoperative indexes including operative time, intraoperative bleeding, complications and length of hospital stay were analyzed to judge the clinical feasibility. Results Except 1 case treated with laparoscopic radiofrequency ablation because of the old age and illness factors and 1 case for conversion to laparotomy, all the rest were treated by LLR with ICG real-time images combined guidance of ultrasound in ICG fluorescent group, and all the patients but one who underwent conversion to laparotomy received general laparoscopic resection in the normal control group. There was no statistical difference between the two groups in terms of operative time [(215.0±35.8)min vs.(208.0±18.6)min, P=0.554]. As compared with the normal control group, the intraoperative bleeding volume significantly reduced [(255.0±19.4)ml vs.(230.0±17.5)ml, P=0.0032], and the hospital stay significantly shortened [(8.9±1.2)d vs.(10.6±1.6)d, P=0.0076], but there was no statistical differences between the two groups in R0 cutting edge and complications(P=0.308; P=0.173). Conclusion Laparoscopic liver resection using ICG fluorescence real-time imaging combined the digital imaging technology under ultrasound guidance is a safe and effective treatment approach for HCC at the special position, being worthy of further promotion clinically.
引文
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[13] Chen L, Luo HP, Zhu P, et al. Preliminary application of realtime fluorescence imaging of indocyanine green in robotic hepatectomy with two cases reported[J]. Abdom Surg, 2017,30(4):254-257.[陈琳,罗鸿萍,朱鹏,等.吲哚菁绿荧光实时成像技术在机器人肝切除中的初步应用(附二例报告)[J].腹部外科,2017, 30(4):254-257.]
[14] Wang HG, Chen MY, Xu YZ. Laparoscopic anatomical hepatectomy guided by fluorescent fusion imaging of indocyanine green[J]. Chin J Gen Surg(Electron Ed), 2017,11(5):372.[王宏光,陈明易,许寅喆.吲哚菁绿荧光融合影像引导的腹腔镜解剖性肝切除术[J].中华普外科手术学杂志(电子版),2017, 11(5):372.]
[15] Dong JH, Ye S. Opening a new era of precise hepatobiliary surgery[J]. Chin J Gen Surg(Electron Ed), 2016, 10(3):181-184.[董家鸿,叶晟.开启精准肝胆外科的新时代[J].中华普外科手术学杂志(电子版),2016, 10(3):181-184.]
[16] Ishizawa T, Fukushima N, Shibahara J, et al. Real-time identification of liver cancers by using indocyanine green fluorescent imaging[J]. Cancer, 2009, 115(11):2491-2504.
[17] Hain E, Lim C, Malek A, et al. Indocyanine green-fluorescence imaging in the assessment of intestinal viability during surgery:can fluorescence replace human eye?[J]. Ann Surg, 2017,265(4):e48-e49.
[18] Lim C, Vibert E, Azoulay D, et al, Indocyanine green fluorescence imaging in the surgical management of liver cancers:current facts and future implications[J]. J Visc Surg, 2014, 151(2):117124.
[19] Miyata A, Ishizawa T, Kamiya M, et al. Photoacoustic tomography of human hepatic malignancies using intraoperative indocyanine green fluorescence imaging[J]. PLoS One, 2014,9(11):e112667.
[20] Tranchart H, Ceribelli C, Ferretti S, et al. Traditional versus robot-assisted full laparoscopic liver resection:a matched-pair comparative study[J]. World J Surg, 2014, 38(11):2904-2909.
[21] Dong JH, Yang SZ. Technical characteristics and clinical application of precise hepatectomy[J]. Chin J Prac Surg, 2010,30(8):638-640.[董家鸿,杨世忠.精准肝切除的技术特征与临床应用[J].中国实用外科杂志,2010, 30(8):638-640.]
[2] Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma[J].Lancet, 2012, 379(9822):1245-1255.
[3] Hu XW, Ding TL, Hong ZX. Therapeutic effect of partial hepatectomy combined with radiofrequency ablation for primary hepatocellular carcinoma[J]. Trauma Crit Care Med, 2018, 6(4):226-227, 230.[胡雄伟,丁同领,洪智贤.部分肝切除术联合射频消融术治疗原发性肝癌疗效分析[J].创伤与急危重病医学,2018, 6(4):226-227, 230.]
[4] Qiu J, Chen S, Chengyou D. A systematic review of roboticassisted liver resection and meta-analysis of robotic versus laparoscopic hepatectomy for hepatic neoplasms[J]. Surg Endosc, 2016, 30(3):862-875.
[5] Li Z, Gao PJ, Gao J, et al. Application of ICG test combined with hepatic image analysis system in liver surgery[J]. Chin J Oper Proc Gen Surg(Electron Ed),2012, 6(3):234-237.[李照,高鹏骥,高杰,等.吲哚菁绿试验联合肝脏影像解读分析系统在肝脏手术中的应用[J].中华普外科手术学杂志(电子版),2012,6(3):234-237.]
[6] Salloum C, Lim C, Malek A, et al. Robot-assisted laparoscopic liver resection:Areview[J]. J Visc Surg, 2016, 153(6):447-456.
[7] Ji WK, Choi SH, Kwon SW, et al. Robot-assisted hepatectomy and complete excision of the extrahepatic bile duct for type IV-A choledochal cysts[J]. Surg Endosc, 2016, 12(30):5626-5627.
[8] Venook AP, Papandreou C, Furuse J, et al. The incidence and epidemiology of hepatocellular carcinoma:a global and regional perspective[J]. Oncologist, 2010, 15(S4):5-13.
[9] Zhou L, Zheng YG, Du GS. Advances in the prevention and treatment of recurrence of liver cancer after liver transplantation[J]. Organ Transpl,2014, 5(5):270-276.[周林,郑永根,杜国盛.索拉非尼防治肝癌肝移植术后复发的研究进展[J].器官移植,2014, 5(5):270-276.]
[10] Du GS, Zhou L, Shi BY, et al. Clinical study of triple anti-tumor therapy for preventing tumor recurrence of terminal primary liver cancer after liver transplantation[J]. Organ Transpl, 2014,5(2):74-78.[杜国盛,周林,石炳毅,等.三联抗肿瘤疗法预防晚期原发性肝癌肝移植术后肿瘤复发的临床研究[J].器官移植,2014, 5(2):74-78.]
[11] Yan Y, Cai X,Geller D A. Laparoscopic liver resection:a reviewof current status[J].J Lapa Adva Surg Tech, 2017,27(5):481-486.
[12] Zhang SX, Jiang HC, Liang LJ, et al. Expert consensus on the application of computer-assisted combined indocyanine green molecular fluorescence imaging in the diagnosis and surgical navigation of liver tumors[J]. Chin J Prac Surg, 2017, 37(5):531-538.[张绍祥,姜洪池,梁力建,等.计算机辅助联合吲哚菁绿分子荧光影像技术在肝脏肿瘤诊断和手术导航中的应用专家共识[J].中国实用外科杂志,2017, 37(5):531-538.]
[13] Chen L, Luo HP, Zhu P, et al. Preliminary application of realtime fluorescence imaging of indocyanine green in robotic hepatectomy with two cases reported[J]. Abdom Surg, 2017,30(4):254-257.[陈琳,罗鸿萍,朱鹏,等.吲哚菁绿荧光实时成像技术在机器人肝切除中的初步应用(附二例报告)[J].腹部外科,2017, 30(4):254-257.]
[14] Wang HG, Chen MY, Xu YZ. Laparoscopic anatomical hepatectomy guided by fluorescent fusion imaging of indocyanine green[J]. Chin J Gen Surg(Electron Ed), 2017,11(5):372.[王宏光,陈明易,许寅喆.吲哚菁绿荧光融合影像引导的腹腔镜解剖性肝切除术[J].中华普外科手术学杂志(电子版),2017, 11(5):372.]
[15] Dong JH, Ye S. Opening a new era of precise hepatobiliary surgery[J]. Chin J Gen Surg(Electron Ed), 2016, 10(3):181-184.[董家鸿,叶晟.开启精准肝胆外科的新时代[J].中华普外科手术学杂志(电子版),2016, 10(3):181-184.]
[16] Ishizawa T, Fukushima N, Shibahara J, et al. Real-time identification of liver cancers by using indocyanine green fluorescent imaging[J]. Cancer, 2009, 115(11):2491-2504.
[17] Hain E, Lim C, Malek A, et al. Indocyanine green-fluorescence imaging in the assessment of intestinal viability during surgery:can fluorescence replace human eye?[J]. Ann Surg, 2017,265(4):e48-e49.
[18] Lim C, Vibert E, Azoulay D, et al, Indocyanine green fluorescence imaging in the surgical management of liver cancers:current facts and future implications[J]. J Visc Surg, 2014, 151(2):117124.
[19] Miyata A, Ishizawa T, Kamiya M, et al. Photoacoustic tomography of human hepatic malignancies using intraoperative indocyanine green fluorescence imaging[J]. PLoS One, 2014,9(11):e112667.
[20] Tranchart H, Ceribelli C, Ferretti S, et al. Traditional versus robot-assisted full laparoscopic liver resection:a matched-pair comparative study[J]. World J Surg, 2014, 38(11):2904-2909.
[21] Dong JH, Yang SZ. Technical characteristics and clinical application of precise hepatectomy[J]. Chin J Prac Surg, 2010,30(8):638-640.[董家鸿,杨世忠.精准肝切除的技术特征与临床应用[J].中国实用外科杂志,2010, 30(8):638-640.]