吲哚菁绿荧光腹腔镜下根治性前列腺切除术5例报告并文献复习  

Application of indocyanine green fluorescence-guided laparoscopy in radical prostatectomy:five cases report and literature review

作　　者：柯鑫文 陈博文 韩伟伟 万志华[1] 昌磊[1] 李忠远[1] 朱晨曦[1] 舒博 KE Xinwen;CHEN Bowen;HAN Weiwei;WAN Zhihua;CHANG Lei;LI Zhongyuan;ZHU Chenxi;SHU Bo(Department of Urology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China)

机构地区：[1]华中科技大学附属武汉市中心医院泌尿外科,430030

出　　处：《现代泌尿生殖肿瘤杂志》2021年第1期30-33,49,共5页Journal of Contemporary Urologic and Reproductive Oncology

基　　金：2017年武汉市卫生健康委重点面上项目(WX17A02)。

摘　　要：目的探讨吲哚菁绿(ICG)引导的荧光腹腔镜在前列腺癌根治性切除术(LRP)+超扩大盆腔淋巴结清扫(sePLND)中的应用价值,并结合相关文献总结该显影技术的特点。方法回顾性分析2020年5月至2020年6月我院采用ICG荧光腹腔镜系统开展LRP+sePLND的5例局部晚期前列腺癌患者的临床资料。所有患者术前均经前列腺穿刺活检证实为前列腺癌,且常规影像学检查提示无远处淋巴结转移、骨转移及内脏转移。预先配制好浓度为25 mg/ml的ICG溶液术中备用。在PINPOINT荧光腹腔镜白光模式下充分分离、暴露出前列腺,用腹腔镜专用的G27注射针头抽取0.4 ml ICG溶液,在前列腺的2、3、9、10点方向向腺体内分别缓慢注射0.1 ml显影剂,片刻后淋巴结即可显示绿色荧光,采用常规与ICG引导相结合的方式行sePLND。结果5例患者均顺利完成手术。患者年龄62~75岁,平均69.4岁;体重指数19.3~26.2 kg/m2,平均22.6 kg/m2;初诊PSA值10.7~48.0 ng/ml,平均23.7 ng/ml;术前穿刺Gleason评分7~9分,平均7.6分;手术时间240~360 min,平均294 min;清扫的淋巴结数量14~23枚,平均17枚。所有患者均成功显影,其中淋巴结阳性1例,阳性淋巴结个数占清扫总数的5.9%(5/85)。5例患者均未出现严重并发症,1例患者术后出现淋巴漏。所有患者均未出现ICG相关的并发症。随访6个月,1例患者出现生化复发,均未出现临床复发。结论ICG引导的荧光腹腔镜在LRP+sePLND中能准确地实时定位可疑盆腔淋巴结,安全性较高,术后并发症少,该显影技术敏感度较高,但特异度有待提高。Objective To explore the application value of indocyanine green(ICG)fluorescence-guided laparoscopy in radical prostatectomy with super extended pelvic lymphadenectomy(LRP+sePLND)and summarize the technical characteristics of fluorescence-enhanced system by reviewing relative literature.Methods A retrospective analysis was conducted on the clinical data of 5 patients with locally advanced prostate cancer in our hospital who underwent LRP+sePLND using the fluorescence-enhanced system between May 2020 and June 2020.All patients were pathologically diagnosed as prostate cancer before surgery by trans-perineal prostate biopsy and classified as locally advanced group without ex-regional nodes metastases,bone metastases or visceral metastases by conventional image workups.During the surgery,the prostate was firstly dissected and exposed in the white light mode using PINPOINT fluorescence laparoscope system.Then 0.1 ml pre-prepared ICG solutions were injected separately by exclusively G27 laparoscope needle into prostate gland on the 2,3,9,10 clockwise direction.After a while,the suspected lymph nodes were displayed green fluorescence on the monitor and were dissected by way of combining conventional and ICG-guided pattern.Results There were 5 patients who were successfully performed the surgery,aged between 62 and 75 years,with an average age of 69.4 years.The body mass indexes ranged from 19.3 to 26.2 kg/m,with an average value of 22.6 kg/m.Preoperative PSA value ranged from 10.7 to 48.0 ng/ml with an average of 23.7 ng/ml,meanwhile,the Gleason score were 7 to 9 with an average of 7.6.The operation time was 240 to 360 minutes with an average of 294 minutes.The number of dissected lymph nodes were 14 to 23 with an average of 17.All patients with suspected lymph nodes were successfully completed the lymphangiography,of which one patient was pathologically identified as positive with 5 invasive lymph nodes.The proportion of positive lymph nodes was 5.9%(5/85).Lymph leakage occurred in one case,but there were no serious c

关 键 词：吲哚菁绿 荧光腹腔镜 前列腺癌 扩大盆腔淋巴结清扫 

分 类 号：R73[医药卫生—肿瘤]