摘要
目的分析腹腔镜下吲哚菁绿(ICG)荧光实时成像联合腹腔镜数字超声引导技术在特殊部位肝癌腹腔镜肝切除中的安全性及有效性。方法选择2016年1月-2017年12月解放军总医院肝胆外科诊断为特殊位置肝脏恶性肿瘤患者24例,其中ICG荧光组(n=12)术前静脉注射ICG,采用荧光腹腔镜进行肝脏切除术,以12例行普通腹腔镜切除者(普通腹腔镜组)为对照。对两组患者的手术时间、术中出血量、并发症、住院时间等术中及术后指标进行分析,并判断腹腔镜ICG荧光实时成像联合数字超声引导技术的临床可行性。结果 ICG荧光组患者1例中转开腹、1例行腹腔镜下射频消融术,其余均完整切除病灶;普通腹腔镜组1例中转开腹,其余11例完成腹腔镜根治性切除。两组患者手术时间差异无统计学意义[(215.0±35.8)min vs.(208.0±18.6)min,P=0.554]。与普通腹腔镜组比较,ICG荧光组术中出血量明显减少[(255.0±19.4)ml vs.(230.0±17.5)ml,P=0.0032],住院时间明显缩短[(8.9±1.2)d vs.(10.6±1.6)d,P=0.0076]。两组患者在手术R0切缘、并发症方面差异无统计学意义(P=0.308;P=0.173)。结论腹腔镜ICG荧光实时成像联合数字超声引导技术在特殊部位肝癌的肝切除中安全、有效,值得临床进一步推广。
Objective To analyze the safety and efficacy of indocyanine green(ICG)fluorescence real-time imaging technology and digital ultrasound guidance technology for laparoscopic liver resection(LLR)of HCC at special location.Methods Twenty-four patients with hepatocellular carcinoma at special location were enrolled and equally divided into two groups:ICG fluorescent group received intravenous indocyanine green injection 2-3 days before operation,and then did fluorescent laparoscopic liver resection,while the normal control group were given general laparoscopic liver resection;meanwhile,the intraoperative and postoperative indexes including operative time,intraoperative bleeding,complications and length of hospital stay were analyzed to judge the clinical feasibility.Results Except 1 case treated with laparoscopic radiofrequency ablation because of the old age and illness factors and 1 case for conversion to laparotomy,all the rest were treated by LLR with ICG real-time images combined guidance of ultrasound in ICG fluorescent group,and all the patients but one who underwent conversion to laparotomy received general laparoscopic resection in the normal control group.There was no statistical difference between the two groups in terms of operative time[(215.0±35.8)min vs.(208.0±18.6)min,P=0.554].As compared with the normal control group,the intraoperative bleeding volume significantly reduced[(255.0±19.4)ml vs.(230.0±17.5)ml,P=0.0032],and the hospital stay significantly shortened[(8.9±1.2)d vs.(10.6±1.6)d,P=0.0076],but there was no statistical differences between the two groups in R0 cutting edge and complications(P=0.308;P=0.173).Conclusion Laparoscopic liver resection using ICG fluorescence real-time imaging combined the digital imaging technology under ultrasound guidance is a safe and effective treatment approach for HCC at the special position,being worthy of further promotion clinically.
作者
陈少华
周林
李晓龙
史宪杰
CHEN Shao-hua;ZHOU Lin;LI Xiao-long;SHI Xian-jie(First Department of General Surgery,Affiliated Hospital of Chifeng Medical College,Chifeng,Inner Mongolia 024005,China;Department of Hepatobiliary Surgery,Chinese PLA General Hospital,Beijing 100853,China)
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2019年第4期336-340,共5页
Medical Journal of Chinese People's Liberation Army
关键词
吲哚菁绿
腹腔镜肝切除
肝癌
数字超声
indocyanine green
laparoscopic liver resection
liver cancer
digital ultrasound
