吲哚菁绿荧光显影应用于腹壁子宫内膜异位症切除术中的初步探讨  

Application of indocyanine green fluorescence visualization in surgical resection of abdominal wall endometriosis

作　　者：梁炎春[1] 廖丹[2] 韦雅婧 黄佳明[1] 吴婷婷 杨如玉 黄碧淇 王兴 姚书忠[1] Yanchun Liang;Dan Liao;Yajing Wei;Jiaming Huang;Tingting Wu;Ruyu Yang;Biqi Huang;Xing Wang;Shuzhong Yao(Department of Gynecology,First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China;Operating Theatre,First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China;Zhongshan School of Medicine,Sun Yat-sen University,Guangzhou 510089,China)

机构地区：[1]中山大学附属第一医院妇科,广州510080 [2]中山大学附属第一医院手术麻醉中心,广州510080 [3]中山大学中山医学院,广州510089

出　　处：《中华妇产科杂志》2021年第12期849-855,共7页Chinese Journal of Obstetrics and Gynecology

基　　金：国家自然科学基金(82071618);广东省科技创新战略专项资金(2021A1515012615);广东大学生科技创新培育专项资金(pdjh2021b0020,pdjh2020b0015);中山大学大学生创新训练计划(20201219,20201220,202110558079);中山大学附属第一医院柯麟新星人才计划(R08013)。

摘　　要：目的探讨吲哚菁绿(ICG)荧光显影应用于腹壁子宫内膜异位症(AWE)切除术的可行性、有效性和安全性。方法收集2021年7月1日至10月1日于中山大学附属第一医院行手术治疗的7例AWE患者,术中采用ICG(0.25 mg/kg)作为荧光显影剂,在近红外荧光腹腔镜辅助下进行AWE病灶的荧光显影,指导AWE的精准切除。切除AWE病灶并取其3、6、9和12点的切缘组织及病灶基底部组织送病理检查。记录静脉推注ICG后至荧光显影的时间、荧光显影率、荧光显影下切除病灶的时间、ICG使用相关的不良反应、围手术期并发症及病灶的病理检查结果。结果入组的7例AWE患者中,有5例患者的AWE病灶在静脉推注ICG后显影(荧光显影率为5/7),静脉推注ICG后至荧光显影的时间为(46.7±9.8)s。ICG荧光显影下切除病灶的时间为(16.4±7.0)min。所有患者均未发生ICG使用相关的不良反应,所有患者的腹壁切口均为甲级愈合。术后病理检查均提示所有切缘未见子宫内膜异位症病灶。结论ICG荧光显影可指导AWE病灶的精准切除,该技术的临床应用安全有效。Objective To investigate the feasibility,effectiveness and safety of indocyanine green(ICG)navigation in the surgical resection of abdominal wall endometriosis(AWE).Methods Seven women undergoing surgery for AWE in First Affiliated Hospital of Sun Yat-sen University(from July 1,2021 to October 1,2021)were collected.After exposure of the focus,ICG were used intravenously(0.25 mg/kg)as fluorescent dye for the intraoperative evaluation of AWE vascularization.Resection of the AWE was guided by direct visualization of the focus under standard laparoscopy with a near-infrared(NIR)camera head.Surgical margin around the AWE(3,6,9 and 12 point)and the margin under the focus were obtained for postoperative pathological examination of endometriosis.Time from injection to fluorescence visualization,the proportion of fluorescence visualization,time of fully resection of AWE,side effects related to the use of ICG,perioperative complications as well as the pathological result of the surgical margins were recorded.Results ICG fluorescence of the AWE were seen in 5 patients(5/7).The mean time from injection to fluorescence visualization was(46.7±9.8)s.The mean time of fully resection of AWE was(16.4±7.0)minutes.There were no side effects related to the use of ICG.The rate of class-A wound healing was 7/7.All of the surgical margins were confirmed endometriosis-negative by postoperative pathological examination.Conclusion ICG fluorescence visualization could conduct accurate resection of AWE,which is clinically safe and effective.

关 键 词：腹壁 子宫内膜异位症 吲哚花菁绿 光学成像 腹腔镜检查 妇科外科手术 

分 类 号：R713.4[医药卫生—妇产科学]