吲哚菁绿近红外荧光显影技术在机器人辅助腹腔镜上尿路修复重建手术中的应用(附手术视频)  

Application of indocyanine green and near-infrared fluorescence imaging in robot-assisted laparoscopic urinary tract repair and reconstruction surgery(with surgical video)

作　　者：左佳乐 李笑然[1] 何綦琪[1] 马腾[1] 石玮[1] 包军胜[1] ZUO Jiale;LI Xiaoran;HE Qiqi;MA Teng;SHI Wei;BAO Junsheng(Department of Urology,the Second Hospital of Lanzhou University,Lanzhou,730030,China)

机构地区：[1]兰州大学第二医院泌尿外科,甘肃兰州730030

出　　处：《机器人外科学杂志（中英文）》2024年第3期412-419,共8页Chinese Journal of Robotic Surgery

基　　金：国家自然科学基金(82160146);兰州大学第二医院萃英科技创新计划项目(CY2020-MS08);兰州大学第二医院萃英科技创新计划项目(CY2021-MS-A12)。

摘　　要：目的:探讨吲哚菁绿(ICG)近红外荧光(NIRF)实时显影技术在机器人辅助腹腔镜上尿路修复重建手术中的可行性及临床应用价值。方法:回顾性分析2021年3月—2023年10月兰州大学第二医院收治的8例行吲哚菁绿引导下机器人辅助腹腔镜上尿路重建修复手术患者的临床资料,8例患者术中均经肾造瘘管和(或)输尿管导管注入吲哚菁绿溶液,通过机器人荧光实时显影技术辅助辨认输尿管,指导手术策略。收集患者基线资料、手术信息及术后随访等资料进行分析。结果:8例患者均顺利完成手术,其中肾盂成形术3例,舌黏膜补片代输尿管术2例,输尿管端端吻合术、膀胱瓣代输尿管术及自体肾移植术各1例,均借助ICG-NIRF技术完成输尿管狭窄段的精准定位及分离,无中转开腹。8例患者平均手术时长257.5(140~330)min,平均术中估计出血量55(5~150)ml,1例二次肾盂成形术患儿术中结肠粘连严重,机械损伤出现肠破裂,同期缝合修复受损结肠,术后愈合良好,其余患者术后恢复良好,无术中及术后短期并发症出现。8例患者平均随访时间5.5(2~19)月,均未见吲哚菁绿副反应。8例患者术后3月复查泌尿系B超,显示肾积水缓解,梗阻解除。3例患者术后4月行泌尿系肾盂输尿管顺行造影示输尿管通畅,拔除造瘘管。结论:吲哚菁绿荧光实时显影技术在复杂机器人上尿路修复重建手术中显示输尿管及狭窄段准确可靠,多种技术的联合有助于实现微创和精准化,值得临床推广。Objective:To explore the feasibility and the clinical application value of indocyanine green(ICG)and near-infrared fluorescence(NIRF)imaging in robot-assisted laparoscopic upper urinary tract repair and reconstruction surgery.Methods:The clinical data of 8 patients who underwent ICG-guided robot-assisted laparoscopic upper urinary tract repair and reconstruction in the Second Hospital of Lanzhou University between March 2021 to October 2023 were retrospectively analyzed.ICG solution was injected into the 8 patients through nephrostomy tube and/or ureteral catheter during operation.Real-time fluorescence imaging technique was used to identify the ureter to help surgical decision-making.Patient characteristics,perioperative outcomes,and complications were analyzed.Results:All the 8 cases of surgery were successfully completed without conversion to laparotomy,including 3cases of pyeloplasty,2 cases of lingual mucosal graft ureteroplasty,1 case of ureteroureterostomy,1 case of bladder muscle flap ureteroplasty and 1 case of kidney autotransplantation.ICG-NIRF technology was used to accurately locate and separate the ureteral stenosis.The average operative time of the 8 patients was 257.5(140 to 330)min,and the average intraoperative blood loss was 55(5 to 150)ml.A child who underwent secondary pyeloplasty for intestinal rupture caused by severe colonic adhesion and mechanical injury.The ascending colon was repaired in one stage and healed well after surgery.The other patients recovered well after the operation,and no intraoperative or short-term postoperative complications occurred.The average follow-up time was 5.5(2 to 19)months,and no ICG side effect was found in the 8 patients.B-ultrasound of urinary system showed that hydronephrosis and obstruction were relieved 3 months after surgery in the 8 patients.Antegrade urography of urinary pelvis and ureter was performed in 3 patients 4 months after surgery,and the results indicated that the ureter was unobstructed and the fistula tube was removed.Conclusion:ICG real-t

关 键 词：吲哚菁绿 舌黏膜补片 输尿管狭窄 自体肾移植 机器人辅助手术 

分 类 号：R608[医药卫生—外科学] R695[医药卫生—临床医学]