实时吲哚菁绿荧光成像导航技术在直肠癌手术中的应用  

Application of real-time indocyanine green fluorescence imaging navigation technology in rectal cancer surgery

作　　者：杨勇[1] 李姗姗[1] 张正国[1] 黄路桥 谢光伟[1] 孟庆良[1] YANG Yong;LI Shanshan;ZHANG Zhengguo;HUANG Luqiao;XIE Guangwei;MENG Qingliang(Department of Anorectal Surgery,Xuzhou Central Hospital,Xuzhou,Jiangsu 221009,P.R.China)

机构地区：[1]徐州市中心医院肛肠科,江苏徐州221009

出　　处：《中国普外基础与临床杂志》2024年第1期45-49,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：徐州市社会发展医药卫生面上项目(项目编号:KC22154)。

摘　　要：目的探讨实时吲哚菁绿荧光成像导航(indocyanine green fluorescence imaging navigation,ICGFIN)技术在腹腔镜直肠癌根治术中的应用价值。方法按照纳入和排除标准回顾性收集2022年4月至2023年6月期间徐州市中心医院肛肠科收治且采用ICG-FIN的腹腔镜直肠癌手术患者(ICG-FIN组),同时采用倾向性评分匹配法以1∶1匹配2021年1月至2022年5月期间未使用ICG-FIN行常规腹腔镜手术患者作为对照组,比较2组的一般资料、手术情况、术中及术后结果。结果本研究ICG-FIN组62例,同时匹配了62例患者作为对照组,2组患者的性别、年龄、身体质量指数、合并症等资料比较差异无统计学意义(P>0.05)。ICG-FIN组术中均可见瘤体定位、淋巴结示踪、预切肠管及吻合口处均荧光显像,术中有7例(11.3%)患者预切肠吻合线改变,对照组无手术计划改变。2组患者在手术方式选择、手术时间、术中出血量、回肠造口比例、术后首次排气时间、术后住院时间及短期并发症发生率方面比较差异均无统计学意义(P>0.05),ICG-FIN组吻合口漏发生率低于对照组且差异有统计学意义(P=0.012),清扫淋巴结数目ICG-FIN组多于对照组(P=0.016),但2组检出阳性淋巴结数目比较差异无统计学意义(P=0.343)。结论从本研究结果提示,ICG-FIN技术在腹腔镜直肠癌手术中可以准确定位肿瘤、示踪淋巴结、指导术中淋巴结清扫,可实时评估吻合口段肠管血流灌注对降低吻合口漏具有一定的优势。Objective To evaluate the value of real-time indocyanine green fluorescence imaging navigation(ICG-FIN)in laparoscopic rectal cancer surgery.Methods The patients who adopted ICG-FIN during laparoscopic rectal cancer surgery in the Department of Anorectal Surgery of Xuzhou Central Hospital from April 2022 to June 2023 according to the inclusion and exclusion criteria(ICG-FIN group)were collected,meanwhile matching(1∶1)of patients who did not adopt ICG-FIN during laparoscopic surgery from January 2021 to May 2022(control group).The general data,surgical conditions,intraoperative and postoperative outcomes between the two groups were compared.Results There were 62 patients in the ICG-FIN group and 62 patients in the control group.There were no statistical differences in the gender,age,body mass index,comorbidities,and so on between the two groups(P>0.05).The tumor localization,lymph node tracing,fluorescence imaging of the intended resection of intestinal tract and anastomotic site were observed in the ICG-FIN group.Seven patients(11.3%)had changed in the intended resection of intestinal anastomotic line during surgery,while there were no changes of the surgical plan in the control group.There were no statistical differences(P>0.05)in terms of surgical method,operative time,intraoperative bleeding,proportion of ileostomy,time of the first postoperative exhaust,postoperative hospital stay,and incidence of short-term complications between the two groups.Compared with the control group,the incidence of anastomotic leakage was lower(P=0.012),and the number of lymph nodes cleaned was more(P=0.016)in the ICG-FIN group.However,there was no statistical difference in the number of positive lymph nodes detected between the two groups(P=0.343).Conclusions According to the results of this study,ICG-FIN is a reliable and effective method during laparoscopic rectal cancer surgery,which can accurately localize tumor,trace and guide lymph node dissection.Real-time evaluation of intestinal blood flow perfusion is of great practica

关 键 词：直肠癌 吲哚菁绿 荧光导航 淋巴结清扫 吻合口血供 

分 类 号：R735.37[医药卫生—肿瘤]