吲哚菁绿荧光导航辅助腹腔镜肝内胆管良性区域梗阻型病变区段肝切除可行性及疗效分析  

Indocyanine green fluorescence imaging laparoscopic segmental resection of intrahepatic bile duct benign obstruction

作　　者：陈江明[1] 濮天 谢青松 郭旗[1] 刘学谦 谢坤[1] 赵义军[1] 刘付宝[1] 耿小平[1] CHEN Jiang-ming;PU Tian;XIE Qing-song;LIU Fu-bao(Department of General Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230088,China)

机构地区：[1]安徽医科大学第一附属医院普外科,安徽合肥230088

出　　处：《中国实用外科杂志》2021年第4期419-422,共4页Chinese Journal of Practical Surgery

基　　金：安徽省科技攻关项目(No.1804h0820239)。

摘　　要：目的探讨外周静脉注射吲哚菁绿(ICG)荧光导航辅助腹腔镜肝内胆管良性区域梗阻型病变区段肝切除的可行性及近期疗效。方法回顾性分析2020年11月至2021年1月安徽医科大学第一附属医院普外科实施的5例外周静脉注射ICG荧光导航辅助腹腔镜肝内胆管良性区域梗阻型病变区段肝切除病例的临床资料。术前15~21 h经外周静脉推注2.5 mg ICG,根据术中ICG荧光显示的病变范围行该区段肝切除术。结果5例病人ICG均在梗阻胆管区段肝脏内滞留,而无胆管梗阻的肝脏组织完成ICG代谢,术中获得肝表面和肝实质内持久的荧光染色导航平面,成功实施ICG荧光导航梗阻胆管区段切除。1例病人诊断为左肝胆管内乳头状肿瘤伴左肝管开口狭窄,另4例病人诊断为肝内胆管结石伴相应胆管区域梗阻狭窄。术中出血量为150(100~200)mL,未输红细胞,手术时间为358(180~465)min,术后住院时间为10(8~13)d。围手术期无Clavien-Dindo分级≥Ⅲ级并发症发生。结论应用ICG荧光导航技术有助于精准定位肝内胆管良性区域梗阻型病变的区段,实施精准肝切除手术。Objective To explore the feasibility,safety and short-term efficacy of peripheral intravenous injection of indocyanine green(ICG)for laparoscopic assisted regional resection of intrahepatic bile duct benign obstruction.Methods The clinical data of 5 cases who underwent indocyanine green fluorescence imaging laparoscopic segmental resection of intrahepatic bile duct benign obstruction in the First Affiliated Hospital of Anhui Medical University from November 2020 to January 2021 were analyzed retrospectively.2.5 mg ICG was injected at 15 to 21 h before operation,and liver resection was performed according to the extent of ICG guided fluorescence.Results In 5 patients,ICG remained in the liver of the obstructive bile duct area,while the surrounding normal liver tissues completed the ICG metabolism.The persistent fluorescent staining navigation plane was obtained on the liver surface and liver parenchyma,and ICG fluorescence navigation was successfully performed to remove the liver of the obstructive bile duct area.One patient was diagnosed as intraductal papillary tumor of left hepatic duct with stenosis,the other 4 patients were diagnosed with segmental bile duct stone with stenosis.The amount of bleeding during operation was 150(100-200)mL,and the operation time was 358(180-465)minutes.Postoperative hospital stay was 10(8-13)days.No perioperative complications of equal to or greater than Clavien-Dindo grade Ⅲ occurred.Conclusion ICG fluorescent imaging is helpful to accurately locate the segment of intrahepatic bile duct obstruction and implement precise hepatectomy.

关 键 词：吲哚菁绿 术中导航 腹腔镜肝切除术 肝内胆管良性区域梗阻型病变 

分 类 号：R6[医药卫生—外科学]