超声引导下经皮经肝注射吲哚菁绿与声诺维混合剂在腹腔镜肝锥形单元切除中的应用研究  

The application of ultrasound-guided percutaneous transhepatic injection of indocyanine green and sonovue mixture in laparoscopic liver cone-unit resection

作　　者：程东辉 杨冲 蒋佶朋[1] 左邦佑 曹文斌 吴昊[1] 杨文昊 游欣雨 张宇[1] CHENG Dong-hui;YANG Chong;JIANG Ji-peng(Department of Hepatobiliary and Pancreatic Surgery,Sichuan Provincial People’s Hospital,School of Medicine,University of Electronic Science and Technology of China,Chengdu 610072,China)

机构地区：[1]四川省医学科学院,四川省人民医院肝胆胰外科,四川成都610072

出　　处：《中国实用外科杂志》2024年第2期211-215,223,共6页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金项目(No.82373189);四川省科学技术厅科技计划项目(No.2021YFS0375);四川省科技厅重点研发基金资助项目(No.2022YFS0596)。

摘　　要：目的探讨超声引导下经皮经肝注射吲哚菁绿(ICG)与声诺维混合剂在腹腔镜肝锥形单元切除中的应用价值。方法回顾性分析四川省人民医院2022年1月至2023年5月超声引导下经皮经肝注射ICG与声诺维混合剂并行ICG荧光成像辅助腹腔镜肝锥形单元切除术的16例病人临床资料。观察指标包括肿瘤荧光显像情况、锥形单元荧光染色情况、病人围手术期指标以及随访情况等。结果16例病人的ICG荧光染色均成功显示肝锥形单元边界且肝脏锥形单元荧光显像均完整包含肿瘤,其中15例病人肝锥形单元荧光边界距离肿瘤边界>1cm,1例病人肝锥形单元ICG荧光显像边界距离肿瘤边界较近约0.5 cm。术后解剖标本切缘距离肿瘤达0.5~1.6cm。16例病人中3例病人穿刺2支门静脉分支,13例病人穿刺1支门静脉分支,与术前评估相似。手术时长在62~121 min,中位时长89 min。术中出血30~110 mL,中位出血量80 mL,术中无输血,无中转开放手术病例。截止至2023-07-12,随访时间2~14个月,病人均未出现术后复发。结论超声引导下经皮经肝注射ICG与声诺维混合剂辅助腹腔镜肝锥形单元切除安全可行,其对于肝脏恶性肿瘤的长期疗效值得进一步研究。Objective To investigate the application value of ultrasound-guided percutaneous transhepatic injection of indocyanine green and sonovue mixture in laparoscopic liver cone-intersection.Methods A total of 16 patients with hepatocellular carcinoma who were admitted to the Sichuan Provincial People's Hospital from January 2022 to May 2023 were retrospectively analyzed.All of them underwent ultrasound-guided percutaneous transhepatic injection of indocyanine green and sonovue mixture in laparoscopic liver cone-unit resection.Observation indicators include tumor fluorescence imaging,cone unit fluorescence staining,perioperative indicators of patients,and follow-up.Results All 16 patients successfully displayed the tumor boundary using ICG fluorescence,and the liver cone-unit ICG fluorescence imaging included the tumor completely.Among them,15 patients had a liver cone-unit fluorescence boundary that was more than 1cm away from the tumor boundary,and 1 patient was about 0.5cm.Postoperative anatomical specimens with a cutting edge of 0.5-1.6 cm.Among 16 patients,3 patients underwent puncture of 2 portal veins,and 13 patients underwent puncture of 1 portal vein,similar to preoperative evaluation.The surgical duration ranges from 62 to 121 minutes,with a median duration of 89 minutes.Intraoperative bleeding was 30-110 mL,with a median bleeding volume of 80 mL.There was no intraoperative blood transfusion or conversion to open surgery.No patients had recurrence after operation,up to July 12,2023,when the follow-up period ranged from 2 to 14 months.Conclusion Ultrasound-guided percutaneous transhepatic injection of a mixture of indocyanine green and sonovue-assisted laparoscopic liver cone-unit resection is safe and feasible.Its long-term effect on liver malignant tumors is worth further study.

关 键 词：肝锥形单位 肝切除术 腹腔镜 荧光成像 吲哚菁绿 声诺维 

分 类 号：R6[医药卫生—外科学]