腹腔镜超声联合三维可视化技术引导门静脉穿刺吲哚菁绿荧光染色在精准解剖性肝段切除术中的应用  

Application of ICG fluorescence staining by laparoscopic ultrasound and 3D visualization guided portal branch puncture approach in anatomical segmentectomy

作　　者：王晓颖 高强 朱晓东 马思宁 朱凯 丁光宇 周俭 樊嘉 Wang Xiaoying, Gao Qiang, Zhu Xiaodong, Ma Sining, Zhu Kai, Ding Guangyu, Zhou Jian, Fan Jia.(Department of Liver Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, Chin)

机构地区：[1]复旦大学附属中山医院肝脏外科,上海200032

出　　处：《中华消化外科杂志》2018年第5期452-458,共7页Chinese Journal of Digestive Surgery

摘　　要：目的探讨腹腔镜超声联合三维可视化技术引导门静脉穿刺吲哚菁绿（ICG）荧光染色在精准解剖性肝段切除术中应用的可行性和安全性。方法采用回顾性横断面研究方法。2016年12月至2018年4月复旦大学附属中山医院运用腹腔镜超声联合三维可视化技术引导门静脉穿刺ICG荧光染色行解剖性肝段切除术患者26例。收集并分析上述患者的临床资料。术前三维可视化重建及门静脉分支流域分析；术中腹腔镜超声定位肿瘤及目标肝段门静脉；腹腔镜超声结合三维可视化图像引导下门静脉穿刺染色；腹腔镜解剖性肝段切除术。观察指标：（1）术中情况：门静脉穿刺成功率、目标肝段、染色效果、术中并发症、手术时间、术中出血量、输血、中转开腹情况、肿瘤直径和距肿瘤最小切缘。（2）术后情况：术后并发症情况（以Clavien-Dindo分级为标准）、住院时间。（3）随访情况：获得随访的患者例数，随访时间，患者术后肿瘤复发情况。采用门诊和电话方式进行随访，了解患者术后肿瘤复发情况。随访时间截至2018年4月。正态分布的计量资料以平均数（范围）表示，计数资料以百分率表示。结果（1）术中情况：26例患者采用腹腔镜超声联合三维可视化技术引导门静脉穿刺成功率达100．0％（26／26），穿刺肝段S8段7例、S7段6例、S2段4例、S3段3例、S6段3例、S5段2例、S4段1例。26例患者门静脉注射ICG荧光染色效果：22例ICG荧光染色效果满意，满意度为84．6％（22／26）；4例未达到预期效果，染色不均匀2例，目标肝段部分区域未覆盖1例，相邻肝段染色致无法确定边界1例。26例患者术中注射ICG无过敏等并发症发生，平均手术时间为184min（60—315min），平均术中出血量为97mL（10-400mL），无术中输血和中转开腹患者。26例患者平均肿瘤直径为3．2cm（1．2—10．0cm），Objective To investigate the feasibility and safty of indocyanine green （ICG） fluorescence staining by laparoscopic ultrasound and three-dimensional （3D） visualization guided portal branch puncture approach in anatomical segmentectomy. Methods The retrospective cross-sectional study was conducted. The clinical data of 26 patients who underwent anatomical segmentectomy using ICG fluorescence staining by laparoscopic ultrasound and 3D visualization guided portal branch puncture approach in the Zhongshan Hospital of Fudan University between December 2016 and April 2018 were collected. The preoperative 3D visualization reconstruction and areas of portal branch perfusion were analyzed, laparoscopic ultrasound localization was intraoperatively applied to tumor and portal vein of targeted hepatic segment, and then portal branch puncture and staining were done under laparoscopic ultrasound and 3D visualization, finally laparoscopic anatomical segmentectomy was performed. Observation indicators： （1） intraoperative situations： success rate of portal vein puncture, targeted hepatic segment, effect of ICG fluorescence staining, intraoperative complications, operation time, volume of intraoperative blood loss, blood transfusion, conversion to open surgery, tumor diameter, the minimum resection margin to tumor; （2） postoperative situations： postoperative complications （Clavien-Dindo classification as a criteria） and duration of hospital stay; （3） follow-up situations： cases with follow-up, follow-up time and postoperative tumor recurrence. Follow-up using outpatient examination and telephone interview was performed to detect postoperative tumor recurrence up to April 2018. Measurement data with normal distribution and count data were respectively described as average （range） and percentage. Results （1） Intraoperative situations： a success rate of laparoscopic ultrasound and 3D visualization guided portal branch puncture in 26 patients was 100. 0% （26/26）, and punctures in S8, S7, S

关 键 词：肝肿瘤 解剖性肝段切除术 腹腔镜检查 介入性超声 三维可视化技术 门静脉造影术 吲哚菁绿 

分 类 号：R735.7[医药卫生—肿瘤]