基于三维重建与ICG荧光引导的腹腔镜下解剖性肝Ⅳ段切除术  

Laparoscopic anatomic segment Ⅳ hepatectomy based on three-dimensional reconstruction and ICG fluorescence guidance

作　　者：王小波 魏永刚[1] WANG Xiaobo;WEI Yonggang(Department of Liver Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]四川大学华西医院肝脏外科,成都610041

出　　处：《中国普外基础与临床杂志》2021年第12期1632-1636,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨肝脏三维重建与吲哚菁绿(ICG)荧光染色肝Ⅳ段切除治疗肝细胞癌的临床应用价值。方法回顾性收集2021年5月四川大学华西医院肝脏外科收治的1例肝细胞癌患者的临床资料。术前对该患者重建肝内血管,并对肿瘤所对应的门静脉、肝静脉进行流域分析,模拟切除范围,术中采用ICG荧光染色行腹腔镜下肝Ⅳ段切除。结果该病例染色后肝脏表面荧光界限清晰,肝实质离断中仍能保持肝内段间荧光界面,切除肝段与术前三维重建规划的方案一致。手术共计用时230 min,出血约200 mL,术后第1天患者行血生化检查提示血浆白蛋白稍偏低,转氨酶、胆红素等均未见明显异常,经输注人血白蛋白后指标恢复正常,于术后第4天康复出院。术后无并发症发生,随访期间未见肿瘤复发及转移。结论三维重建与ICG荧光引导对于腹腔镜下解剖性肝Ⅳ段切除治疗肝细胞癌安全可行,且ICG荧光肝段染色方式推荐正染法。Objective To investigate the clinical value of three-dimensional reconstruction of liver and resection of hepatocellular carcinoma with indocyanine green(ICG) fluorescence staining. Methods Clinical data of a patient with hepatocellular carcinoma admitted to the Department of Liver Surgery of West China Hospital of Sichuan University in May 2021 were retrospectively collected. In this patient, intrahepatic vascular reconstruction was performed by SYNAPSE3 D software of Japan before operation, and the portal vein and hepatic vein corresponding to the tumor were analyzed to simulate the resection range. Intraoperative ICG fluorescence staining was used to perform laparoscopic resection of segment Ⅳ of the liver. Results In this patient, the fluorescence boundary on the liver surface was clear after staining,and the intrahepatic segment fluorescence interface could still be maintained in the hepatic parenchyma dissociation, and the resection of the liver segment was consistent with the preoperative three-dimensional reconstruction plan. The operation took 230 min in total, and the bleeding was about 200 mL. On the first day after the operation, blood biochemical test showed that the plasma albumin was slightly low, and no obvious abnormalities were observed in transaminase, bilirubin, etc. After the infusion of human albumin, the indexes returned to normal, and the patient recovered and was discharged on the fourth day after the operation. No complications occurred after the operation, and no tumor recurrence and metastasis were observed during follow-up period. Conclusion 3 D reconstruction and ICG fluorescence guidance are safe and feasible for the treatment of hepatocellular carcinoma after laparoscopic anatomic segment Ⅳ resection, and the positive staining method of ICG fluorescence segment is recommended.

关 键 词：三维重建 吲哚菁绿 解剖性肝切除 

分 类 号：R735.7[医药卫生—肿瘤]