吲哚菁绿荧光实时显影技术在儿童复杂肾积水机器人辅助腹腔镜手术中的初步应用  

Applications of indocyanine green and near-infrared fluorescence during complex robot-assisted laparoscopic pyeloplasty

作　　者：马立飞 周辉霞 周晓光 陶天 曹华林 李品 赵扬 郭涛 朱炜玮 Ma Lifei;Zhou Huixia;Zhou Xiaoguang;Tao Tian;Cao Hualin;Li Pin;Zhao Yang;Guo Tao;Zhu Weiwei(Department of Pediatric Urology,Bayi Children's Hospital,Affiliated Seventh Medical Center of PLA General Hospital,Beijing 100700,China)

机构地区：[1]中国人民解放军总医院第七医学中心附属八一儿童医院泌尿外科,北京市100700

出　　处：《临床小儿外科杂志》2021年第10期921-924,共4页Journal of Clinical Pediatric Surgery

基　　金：北京市科技计划(编号:Z181100001718008);军队计生专项(编号:18JS001)。

摘　　要：目的初步探讨吲哚菁绿荧光实时显影技术在机器人辅助腹腔镜儿童复杂肾盂成形术中的应用价值。方法回顾性分析2017年10月至2019年8月中国人民解放军总医院第七医学中心附属八一儿童医院收治的、术中应用吲哚菁绿荧光实时显影技术的复杂肾盂输尿管连接部梗阻患者临床资料,共36例,男29例,女7例,年龄3~126个月,中位年龄58个月。36例均在全麻下行机器人辅助腹腔镜下肾盂成形术,其中初次多发狭窄或长段狭窄手术8例,二次手术28例。行肾盂翻瓣成型术18例,口腔黏膜代输尿管10例,阑尾代输尿管5例,回肠代输尿管3例。术中均静脉注射吲哚菁绿,利用机器人系统的集成荧光成像功能对区域血流进行实时显影分析,并收集患者手术时间、术中出血量、术后并发症、留置引流管时间、术后恢复饮食时间、术后住院天数、术后随访等资料进行分析。结果36例均顺利完成手术,无一例中转开放手术或出现术中并发症。手术时间65~150 min,平均(93.2±16.7)min。术中出血量10~50 mL,平均(26.8±8.3)mL。根据荧光显影血流灌注区域可视化成像结果,重建后输尿管均显影,其中35例血供良好,1例行二次肾盂成形术、阑尾代输尿管患者血供较差,荧光显影显示血供较差,后截取回肠段行回肠代输尿管肾盂成形术。结论吲哚菁绿荧光显影区域血流的可视化成像技术能清楚、直观显示机器人辅助复杂儿童肾盂成形术中输尿管的血供情况,指导手术切除策略,对提高手术安全性及临床疗效有一定的作用。Objective To explore the feasibility and effect of indocyanine green(ICG)and near-infrared fluorescence(NIRF)technology during robot-assisted laparoscopic pyeloplasty.Methods Thirty-six children of severe hydronephrosis or failed primary pyeloplasty were recruited between October 2017 and August 2019.There were 29 boys and 7 girls with a median age of 58(3-126)months.Eight cases were operated for primary ureteropelvic junction obstruction(UPJO)while another 28 children underwent secondary pyeloplasty.Pelvic flap,appendix,ileum and oral mucosa were employed as substitutive materials for ureteral reconstruction.The relevant clinical data were analyzed.Results All operations were successful.Operative duration was 65-150 min and volume of blood loss 10-50 mL.There was no intraoperative complication or conversion into open surgery.After an injection of ICG,35 children had a sufficient perfusion and one case of appendix replacement a bad perfusion.Ileoureteral substitution was performed instead.Conclusion The injection of ICG and subsequent NIRF is feasible,safe and effective during robot-assisted laparoscopic pyeloplasty.

关 键 词：荧光染料 吲哚菁绿 机器人 腹腔镜检查 肾积水 诊断显像 

分 类 号：R917.76[医药卫生—药物分析学] R692.2[医药卫生—药学]