吲哚菁绿荧光引导下腹腔镜解剖性肝切除术的临床效果  

Use of indocyanine green fluorescence navigation in laparoscopic anatomical hepatectomy

作　　者：侯子琪 谢青云 廖明恒[1] 刘畅[1] 邱国腾 金兆星 米峙铮 黄纪伟[1] Hou Ziqi;Xie Qingyun;Liao Mingheng;Liu Chang;Qiu Guoteng;Jin Zhaoxing;Mi Shizheng;Huang Jiwei(Department of Liver Surgery and Liver Transplantation Center,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院肝脏外科,成都610041

出　　处：《中华外科杂志》2023年第5期368-374,共7页Chinese Journal of Surgery

摘　　要：目的探讨吲哚菁绿(ICG)荧光引导下腹腔镜解剖性肝切除术治疗原发性肝细胞癌的临床效果。方法回顾性收集2020年9月到2022年5月四川大学华西医院肝脏外科术中使用ICG荧光引导下腹腔镜肝切除术治疗的72例原发性肝细胞癌患者资料。男性53例,女性19例,年龄(55.5±12.9)岁(范围:42.6~68.4岁)。患者肝功能Child-Pugh分级均为A级。其中接受超选择性经肝动脉荧光正染13例(动脉正染组),接受门静脉反染43例(门静脉反染组),接受门静脉穿刺正染16例(门静脉正染组)。三组间定量资料的比较采用单因素方差分析或秩和检验。分类资料采用χ^(2)检验或Fisher确切概率法。结果术后病理学检查结果显示,所有手术均达到根治性切除。动脉正染组、门静脉反染组、门静脉正染组的肿瘤最大径[M(IQR)]分别为2.5(2.4)cm、3.0(2.5)cm、3.0(2.4)cm,距肿瘤最小切缘分别为1.1(1.1)cm、1.0(1.0)cm、1.1(1.6)cm,差异均无统计学意义(P=0.364、0.878)。动脉正染组、门静脉反染组、门静脉正染组的手术时间分别为(348±93)min、(277±112)min、(295±116)min,出血量分别为80(150)ml、200(350)ml、100(150)ml,差异均无统计学意义(P=0.134、0.743)。所有病例术中均未输血,均未中转开腹。动脉染色组术后第1、2天的ALT水平较门静脉反染组高[(559±398)IU/L比307(257)IU/L,q=235.5,P=0.004;(611±389)IU/L比(331±242)IU/L,q=265.2,P=0.002]。门静脉正染组和反染组均有1例发生Clavien-Dindo并发症分级系统Ⅲ级并发症。所有病例术后2个月复查肿瘤标志物,均降至正常范围内。结论经动脉流域或门静脉流域进行ICG荧光引导的腹腔镜解剖性肝切除术治疗原发性肝细胞癌较为安全可行。Objective To examine the clinical value of fluorescence-guided indocyanine green(ICG)laparoscopic anatomical hepatectomy in the treatment of primary hepatocellular carcinoma.Methods Data from patients diagnosed with hepatocellular carcinoma and who underwent laparoscopic hepatectomy with ICG fluorescence navigation in the Department of Liver Surgery and Liver Transplantation Center of West China Hospital between September 2020 and May 2022 were retrospectively collected.There were 53 males and 19 females,with an age of(55.5±12.9)years(range:42.6 to 68.4 years).Among them,13 of the cases underwent laparoscopic anatomical liver resection(LALR)guided by tans-arterial ICG,43 of the cases received LAIR guided by portal vein negative ICG,and 16 of the cases received LALR positive by portal vein.Comparison among the three groups was performed by one-way ANOVA;and the rank sum test was used for comparison between groups.The counting data was expressed as percentage,and theχ^(2) test or Fisher′s exact probability method was used for comparison between groups.Results Resection R0 was achieved in all operations.The maximum tumor diameter of the patients in the arterial staining group,the reverse staining group,and the positive staining group(M(IQR))was 2.5(2.4)cm,3.0(2.5)cm and 3.0(2.4)cm,respectively.There were no statistically significant differences in the maximum tumor diameter between the three groups(P=0.364).The minimum tumor margin was 1.1(1.1)cm,1.0(1.0)cm and 1.1(1.6)cm in the the arterial staining group,reverse staining group and the positive staining group,respectively.There was no significant difference in the margin among the three groups(P=0.878).The operation time of the arterial staining group,the negative staining group,and the positive portal staining group was(348±93)minutes,(277±112)minutes,and(295±116)minutes,respectively.There were no significant differences in operation time among the three groups(P=0.134).The intraoperative blood loss of the three groups was 80(150)ml,200(350)ml,and 100(150)m

关 键 词：肝切除术 腹腔镜 吲哚菁绿 荧光显像 腹腔镜解剖性肝切除术 经肝动脉荧光染色 

分 类 号：R735.7[医药卫生—肿瘤]