吲哚菁绿在肾肿瘤切除术中的成像特征及临床效果  

Imaging characteristics and clinical efficacy of indocyanine green in renal tumor surgery

作　　者：李钊俊 沈俊文 王荣江 Li Zhaojun;Shen Junwen;Wang Rongjiang(Department of Urology,The First Affiliated Hospital of Huzhou Normal College,Huzhou,Zhejiang 31300,China;Huzhou Key Laboratory of Precise Diagnosis and Treatment of Urinary Tumors,Huzhou,Zhejiang 31300,China)

机构地区：[1]湖州师范学院附属第一医院泌尿外科,浙江湖州313000 [2]湖州市泌尿系肿瘤精准化诊疗重点实验室,浙江湖州313000

出　　处：《泌尿外科杂志（电子版）》2024年第3期43-48,共6页Journal of Urology for Clinicians(Electronic Version)

基　　金：浙江省公益技术研究计划(LGF22H160022);浙江省卫生健康面上项目(2021KY345);湖州市科技计划项目(2020GYB30)。

摘　　要：目的探讨吲哚菁绿(indocyanine green,ICG)近红外荧光成像在肾肿瘤切除术中的成像特征及临床应用效果。方法回顾性分析2020-2023年湖州师范学院附属第一医院收治的110例行肾肿瘤切除术患者的临床资料,肾透明细胞癌患者86例,其他肾脏肿瘤患者24例。静脉注射造影剂ICG 1 ml,使用近红外荧光成像系统观察肾脏及肾肿瘤。根据术中近红外荧光成像情况按荧光强度分为低荧光组和强荧光组,采集两组患者的临床信息、手术资料、近红外荧光成像特征。采用免疫组化分析胆红素转位酶(bilitranslocase,BTL)蛋白在肾透明细胞癌组织的表达水平,探索肾透明细胞癌中BTL蛋白表达水平与ICG近红外荧光成像特征之间的内在联系。结果两组患者的临床信息、手术资料对比,差异无统计学意义(P>0.05)。两组肾动脉阻断时间[低荧光组比强荧光组为20.00(18.00,22.50)比25.00(25.00,30.00)min]、近红外荧光成像特征对比,差异有统计学意义(P<0.05)。低荧光组82例,均为肾透明细胞癌,癌组织在ICG近红外荧光成像中呈“低荧光”特征(P<0.01);强荧光组28例,包括呈“强荧光”特征的其他4例肾透明细胞癌患者和24例非肾透明细胞癌患者。结论在ICG近红外荧光成像下,仅肾透明细胞癌呈“低荧光”现象,而其他肾脏肿瘤呈“强荧光”现象。BTL蛋白在肾透明细胞癌组织中呈低表达,其可能为肾透明细胞癌呈“低荧光”的关键分子。开展ICG近红外荧光成像辅助下的肾部分切除术可识别低荧光图像以辨别肾肿瘤边界,缩短肾动脉阻断时间,保护肾功能。Objective To investigate the imaging characteristics and clinical application effects of indocyanine green(ICG)near-infrared fluorescence imaging in renal tumor surgery.Methods A retrospective analysis was conducted on 110 patients who underwent kidney tumor surgery at The First Affiliated Hospital of Huzhou Normal College from 2020 to 2023.Among these,86 patients had renal clear cell carcinoma and 24 patients had other renal tumors.The contrast agent indocyanine green(1 ml)was injected intravenously,and the kidney and renal tumor were observed using a near-infrared fluorescence imaging system.The patients were categorized into low fluorescence and strong fluorescence groups based on the intensity of fluorescence following near-infrared fluorescence imaging.Clinical information,surgical data,and near-infrared fluorescence imaging features of both patient groups were collected.Immunohistochemistry was used to analyze the expression level of bilitranslocase(BTL)protein in renal clear cell carcinoma tissues,exploring the intrinsic link between BTL protein expression levels and ICG near-infrared fluorescence imaging features in renal clear cell carcinoma.Results The clinical information and surgical data showed no statistically significant differences between the two patient groups(P>0.05).However,there was a statistically significant variance in renal artery occlusion time[low fluorescence group vs.strong fluorescence group is 20.00(18.00,22.50)min vs.25.00(25.00,30.00)min]and near-infrared fluorescence imaging features between the two groups(P<0.05).The low fluorescence group comprised 82 cases,all of which were diagnosed with renal clear cell carcinoma.The tumor tissue exhibited"low fluorescence"characteristics on ICG near-infrared fluorescence imaging(P<0.01).The strong fluorescence group consisted of 28 cases,including 4 additional patients with clear cell carcinoma showing"strong fluorescence"characteristics and 24 patients with non-clear cell carcinoma.Conclusions In ICG near-infrared fluorescence imaging,only

关 键 词：吲哚菁绿 肾肿瘤 肾透明细胞癌 胆红素转位酶蛋白 

分 类 号：R737.11[医药卫生—肿瘤]