三维可视化技术联合术中ICG荧光显像在腹腔镜肝癌肝切除术中的应用  

Application of three-dimensional visualization combined with intraoperative indocyanine green fluorescence imaging in laparoscopic hepatectomy for liver cancer

作　　者：李锟[1] 张中林[1] 刘权焰[1] 常磊[1] 李震[1] 潘定宇[1] 刘志苏[1] 袁玉峰[1] Li Kun;Zhang Zhonglin;Liu Quanyan;Chang Lei;Li Zhen;Pan Dingyu;Liu Zhisu;Yuan Yufeng(Department of Hepatobiliary and PancreaticSurgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院肝胆胰外科,430071

出　　处：《中华肝脏外科手术学电子杂志》2019年第3期226-229,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：湖北省卫生卫计委重点支撑项目(WJ2017Z007)

摘　　要：目的探讨三维可视化技术联合术中ICG荧光显像在腹腔镜原发性肝癌(肝癌)肝切除术中的应用价值。方法回顾性分析2017年6月至2018年6月武汉大学中南医院联合应用三维可视化技术和术中ICG荧光显像技术行腹腔镜肝切除术的51例肝癌患者临床资料。其中男24例,女27例;平均年龄(57±15)岁。患者均签署知情同意书,符合医学伦理学规定。术前应用三维可视化技术进行肝脏三维重建,明确肝内脉管系统的解剖关系及其与肿瘤的毗邻关系。术中ICG荧光显像技术和彩色多普勒超声确定肝切除线,行精准肝切除。观察手术时间、术中出血量、并发症发生率、围手术期死亡率等。结果 51例患者均成功实施腹腔镜肝切除术,无术中中转开腹病例。手术时间为(260±150)min,术中出血量(196±104)ml,术后住院时间(9±3)d。无发生术后肝衰竭和围手术期死亡。术后发生并发症5例,均为Clavien-DindoⅡ级,经保守治疗后治愈出院。随访期间4例患者出现肝癌复发或转移。结论三维可视化技术联合ICG荧光显像技术能清晰显示肝癌与肝脏脉管结构的关系,并能准确预测肝癌肝切除范围,提高腹腔镜肝切除术的安全性。Objective To explore the application value of three-dimensional (3D) visualization combined with intraoperative indocyanine green (ICG) fluorescence imaging in laparoscopic hepatectomy for primary liver cancer (PLC). Methods Clinical data of 51 patients with PLC who underwent laparoscopic hepatectomy using 3D visualization combined with intraoperative ICG fluorescence imaging in Zhongnan Hospital of Wuhan University from June 2017 to June 2018 were retrospectively analyzed. Among them, 24 patients were male and 27 female, aged (57±15) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. 3D reconstruction of the liver was performed by 3D visualization before operation to clarify the anatomy of hepatic vascular system and its relationship with the tumors. The resection line was determined with intraoperative ICG fluorescence imaging and color Doppler ultrasound and precise hepatectomy was performed subsequently. The operation time, intraoperative blood loss, incidence of complications and perioperative mortality were observed. Results All 51 patients underwent laparoscopic hepatectomy successfully. No patient was transferred to open surgery. The operation time was (260±150) min, the intraoperative blood loss was (196±104) ml, and the postoperative length of hospital stay was (9±3) d. No postoperative liver failure or perioperative death occurred. Postoperative complications occurred in 5 cases, all of which were Clavien-Dindo grade II. All patients were cured and discharged after receiving conservative treatments. During the postoperative followup, recurrence or metastasis of liver cancer occurred in 4 patients. Conclusions 3D visualization combined with ICG fluorescence imaging can display the relationship between the liver cancer and hepatic vascular structure clearly, and accurately predict the range of liver resection and improve the safety of laparoscopic hepatectomy.

关 键 词：腹腔镜 肝切除术 癌 肝细胞 成像 三维 吲哚氰绿 荧光显像 

分 类 号：R735.7[医药卫生—肿瘤]