吲哚菁绿荧光成像技术在肝癌切除术中识别微小癌灶的价值  

The value of indocyanine fluorescence imaging for the identification of microhepatocellular carcinoma in hepatectomy

作　　者：夏桂辉 贾昌俊[1] 徐锋[1] 赵阳[1] 戴朝六[1] XIA Guihui;JIA Changjun;XU Feng;ZHAO Yang;DAI Chaoliu(Department of Hepatobiliary and Splenic Surgery,Shengjing Hospital,China Medical University,Shenyang 110004,China;Department of General Surgery,Shenyang 242nd Hospital,Shenyang 110141,China)

机构地区：[1]中国医科大学附属盛京医院肝胆脾外科,沈阳110004 [2]沈阳二四二医院普通外科,沈阳110141

出　　处：《中国医科大学学报》2020年第10期899-906,共8页Journal of China Medical University

基　　金：辽宁省自然科学基金(2017225032);沈阳市科学技术计划(17-230-9-16)。

摘　　要：目的探讨吲哚菁绿(ICG)荧光成像技术在肝癌切除术中识别微小肝癌的可行性和临床价值。方法选取2016年12月至2017年9月中国医科大学附属盛京医院肝胆脾外科行肝癌切除术的患者59例。探测并记录肝癌切除术后离体标本中肿瘤及其周边肝组织的荧光显影情况,同时切取呈高亮显影的微小病灶(直径0.2~2.0 cm)及无显影的非癌性肝组织(直径=1 cm),后者作为对照,均行常规病理学检查。应用统计学方法分析肝癌及瘤周微小显影灶显影结果的影响因素。结果59例患者中有50例肝癌显像,26例患者的离体标本探测出微小的瘤周显影灶;共发现微小显影灶65枚,其中4枚经病理证实为肝癌。统计学分析结果显示,肿瘤直径越大越易显影(P<0.05),肝癌肿瘤分化程度与其剖面荧光显影模式存在显著相关性(P<0.05)。未找到瘤周微小显影灶显像的明显相关因素。在探测范围内,ICG荧光成像技术探测出肝癌瘤周微小癌灶的正确率为34.40%。结论ICG荧光成像技术在检测肝表面微小肝癌方面有一定的临床价值。Objective To explore the feasibility and the clinical value of indocyanine green(ICG)-mediated near-infrared fluorescence imaging for identifying liver cancer lesions.Methods Fifty-nine patients who underwent hepatocellular carcinoma resection in the Department of Hepatobiliary and Splenic Surgery in the Shengjing Hospital of the China Medical University from December 2016 to September 2017 were selected for this study.The fluorescence imaging patterns of tumor lesions and peripheral liver tissue in the isolated specimens after hepatectomy were detected and recorded.At the same time,the small lesions(diameter=0.2 to 2 cm)with high-contrast development and non-cancerous liver tissue without development(diameter=1 cm)were cut out.The latter were used as the control group and both sample types underwent routine pathological examination and the results were recorded.Statistical methods were used to analyze the factors affecting fluorescence imaging results of hepatocellular carcinoma and peripheral microimaging lesions.Results HCC were detected via ICG fluorescence imaging in 50 out of 59 patients,while peripheral microimaging lesions with bright fluorescence in in vitro specimens was found in 26 patients.Sixty-five microscopic lesions were found,four of which were pathologically confirmed as hepatocellular carcinoma.Statistical analysis showed that the larger the tumor diameter was,the easier the fluorescence imaging was(P<0.05).Furthermore,the degree of tumor differentiation significantly correlated with the tumor profile in fluorescence imaging(P<0.05).No obvious correlation factor has been found for perinocarcinoma fluorescence microlesion imaging.Within the detection range,the accuracy of ICG fluorescence imaging in detecting pericancerous microlesions was 34.40%.Conclusion ICG fluorescence imaging has a certain clinical value for the detection of small hepatocellular carcinoma on the liver surface.

关 键 词：吲哚菁绿 肝细胞癌 微小肝癌 

分 类 号：R604[医药卫生—外科学]