吲哚菁绿标记的荧光实时显影技术在腹腔镜肾部分切除术中的应用  

Usefulness of the indocyanine green fluorescence imaging technique in laparoscopic partial nephrectomy

作　　者：张树栋[1] 洪鹏 王滨帅[1] 邓绍晖 张帆[1] 陶立元[2] 曹财广 胡振华[3] 马潞林[1] ZHANG Shu-dong;HONG Peng;WANG Bin-shuai;DENG Shao-hui;ZHANG Fan;TAO Li-yuan;CAO Cai-guang;HU Zhen-hua;MA Lu-lin(Department of Urology,Peking University Third Hospital,Beijing 100191,China;Clinical Research Center of Epidemiology,Peking University Third Hospital,Beijing 100191,China;Chinese Academy of Sciences Automation Research Institute,Chinese Academy of Sciences Key Laboratory of Molecular Imaging,Beijing 100190,China)

机构地区：[1]北京大学第三医院泌尿外科,北京100191 [2]北京大学第三医院临床流行病学研究中心,北京100191 [3]中国科学院自动化研究所,中国科学院分子影像重点实验室,北京100190

出　　处：《北京大学学报（医学版）》2020年第4期657-662,共6页Journal of Peking University:Health Sciences

基　　金：北京大学第三医院队列建设项目(BYSYDL2019010)。

摘　　要：目的:评估吲哚菁绿(indocyanine green,ICG)标记的荧光实时显影技术在腹腔镜肾部分切除术中应用的可行性和效果。方法:回顾性分析北京大学第三医院在2019年7月至2020年1月由单一术者所行25例患者ICG标记的近红外荧光腹腔镜肾部分切除术的临床资料,通过荧光显影,精准定位肿瘤,辨认切缘,并在实时显像下完整切除肿瘤,其中1例为双肾肿瘤,共进行26例次手术。收集患者围手术期的临床资料进行统计分析,计量资料采用中位数(范围)表示,计数资料采用百分率表示。男19例,女6例,年龄29~77岁,平均年龄54岁,体重指数25.4(20.0~35.4)kg/m^2,肿瘤位于肾上极11个(42%)、中部6个(23%)、下极9个(35%),肿瘤大小为2.75(1.30~5.20)cm,R.E.N.A.L评分为7.5(5.0~10.0)。肿瘤术前临床分期:T1aN0M023个(88.5%),T1bN0M02个(7.7%),T2aN0M01个(3.8%)。结果:25位患者共行26例次手术,患者术中注射ICG无过敏、感染等并发症发生,无术中输血和中转开放者,所有手术切缘均阴性。手术时间为136(50~247)min,热缺血时间为14(7~30)min。术中估计失血量为50(10~400)mL,住院日为5.5(3.0~31.0)d。术后出现肾周血肿1例,尿漏1例,呼吸衰竭伴下肢静脉血栓1例,经相应治疗后均痊愈,其余无严重并发症发生。随访时间为4~10个月,无肿瘤复发和转移。结论:ICG标记的荧光实时显影技术应用于腹腔镜肾部分切除术安全、有效,有助于肿瘤的精准定位和切除。Objective:To detail a novel technique for marking renal tumors with intravenous indocyanine green(ICG)during laparoscopic partial nephrectomy,and to investigate the feasibility and safety of this technique with the use of near-infrared fluorescence imaging.Methods:Between July 2019 and January 2020,25 consecutive cases with renal masses underwent intraoperative ICG tumor marking laparoscopic partial nephrectomy,at the department of urology in Peking University Third Hospital by the same surgeon.The key benefits included quick intraoperative identification of the mass with improved visualization and real-time control of resection margins by the ICG Immunofluorescence imaging technique.Clinical data were prospectively collected in our institutional database.Perioperative,pathological,and clinical outcomes of the partial nephrectomy were assessed.Measurement data with normal distribution and count data were respectively described as M(range)and percentage.Among these cases,16 cases were male and 9 cases female,The median body mass index was 25.4(20.0-35.4)kg/m^2.The average age was 54(29-77)years.The maximum tumor diameter was 2.75(1.30-5.20)cm.The R.E.N.A.L score was 7.5(5.0-10.0).The tumor locations were distributed with upper pole(11,42%),middle(6,23%),and lower pole(9,35%).The clinical stages of the tumor were described as follows:T1aN0M0(23,88.5%),T1bN0M0(2,7.7%),T2aN0M0(1,3.8%).Results:All the 25 cases were performed 26 times with intraoperative ICG tumor marking laparoscopic partial nephrectomy.There were no allergy,infection and other complications with intravenous indocyanine green.The surgical procedure was successful in all the patients.No conversion and blood transfusion were needed.All the cases of the surgical margin were negative.Overall the operative time was 136(50-247)min and warm ischemia time was 14(7-30)min.The estimated blood loss was 50(10-400)mL and the hospital stay was 5.5(3.0-31.0)days.One case with perirenal hematoma,one case with urine leak,one with respiratory failure and deep venous th

关 键 词：吲哚菁绿 肾部分切除 荧光显像 腹腔镜 

分 类 号：R737.11[医药卫生—肿瘤]