ICG荧光导航技术在晚期口腔鳞癌救治性手术中的应用  

Application of ICG fluorescence navigation during salvage surgery for advanced oral squamous cell carcinoma

作　　者：吴朱昊 张兴伟 孙亚威 李子慧 陈欣[1] 蒲玉梅[1] 胡勤刚[1] 董迎春[1] 孙国文[1] WU Zhu-hao;ZHANG Xing-wei;SUN Ya-wei;LI Zi-hui;CHEN Xin;PU Yu-mei;HU Qin-gang;DONG Ying-chun;SUN Guo-wen(Department of Oral and Maxillofacial Surgery,Nanjing Stomatological Hospital,Affiliated Hospital of Medical School,Nanjing University.Nanjing 210008,Jiangsu Province,China)

机构地区：[1]南京大学医学院附属口腔医院,南京市口腔医院口腔颌面外科,江苏南京210008

出　　处：《中国口腔颌面外科杂志》2023年第3期248-252,共5页China Journal of Oral and Maxillofacial Surgery

摘　　要：目的:探讨吲哚菁绿(indocyanine green,ICG)荧光导航技术检测晚期口腔鳞癌(oral squamous cell carcinoma,OSCC)手术安全切缘的效果。方法:选择2020年1月至2022年6月南京市口腔医院口腔颌面外科一病区收治的晚期OSCC患者48例,分为ICG组(25例)和非ICG组(23例)。ICG组在ICG荧光导航技术辅助下切除肿瘤,非ICG组利用常规方法切除肿瘤,比较2组患者手术时间、术中出血量、切缘异常率及预后等,采用SPSS 22.0软件包对数据进行统计学分析。结果:48例患者均成功完成手术,病灶切除完整并保障了足够的安全切缘。ICG组25例患者在近红外荧光分子成像技术(near infrared fluorescence,NIR)激发下,病灶均可见肿瘤荧光显影,肿瘤边界清晰。平均手术时间8.1 h,平均术中出血量856.4 mL,切缘异常率为1.8%。非ICG组平均手术时间7.7 h,平均术中出血量796.1 mL,切缘异常率为6.9%。截至2022年12月,ICG组3例因复发死亡,1例因术后肿瘤远处转移死亡;对照组4例因复发死亡,1例因术后肺部感染死亡。结论:ICG荧光显像技术为术中直视下完整切除肿瘤,及时发现切缘肿瘤残留提供了新方法,在明确晚期OSCC患者的安全切缘方面具有一定临床意义。PURPOSE:To investigate the efficacy of indocyanine green(ICG)fluorescence navigation technique in the detection of safe surgical margins of advanced oral squamous cell carcinoma(OSCC).METHODS:Forty-eight patients with advanced oral squamous cell carcinoma treated in the First Ward of Department of Oral and Maxillofacial Surgery,Nanjing Stomatological Hospital were divided into ICG group(n=25)and non-ICG group(n=23).The tumor was removed in ICG group with the assistance of ICC fluorescence navigation technology,and the tumor was removed in non-ICG group with conventional methods,and the cutting edge tissues of the two groups underwent frozen biopsy.The operative time,intraoperative blood loss,abnormal margin rate and prognosis of the two groups were observed and compared,and the data were statistically analyzed by SPSS 22.0 software package.RESULTS:The operation was successfully completed in all 48 patients,and the lesion resection was complete and an adequate surgical safety margin was guaranteed.In the ICG group,the tumor fluorescence was visualized in all lesions with clear tumor boundary under the excitation of near-infrared fluorescence molecular imaging.The mean operative time was 8.1 hours,the mean intraoperative blood loss was 856.4 mL,and the rate of abnormal margins was 1.8%.The mean operative time in the non-ICG group was 7.7 hours,the mean intraoperative blood loss was 796.1 mL,and the rate of abnormal margins was 6.9%.By December 2022,3 patients in the ICG group had died due to recurrence and 1 patient had died due to distant metastasis after surgery.In the control group,4 cases died due to recurrence and 1 case died due to postoperative pulmonary infection.CONCLUSIONS:ICG mediated near infrared fluorescence imaging technology provides a new method for observing and completely resecting the tumor under direct vision during operation,and finding the residual tumor at the cutting edge in time,which has a certain significance in the treatment of advanced oral squamous cell carcinoma.

关 键 词：近红外荧光分子成像技术 晚期口腔鳞癌 手术安全切缘 吲哚菁绿 

分 类 号：R739.8[医药卫生—肿瘤]