中国实用外科杂志

中国实用外科杂志

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吲哚菁绿荧光融合影像引导精准右半肝切除治疗肝细胞癌临床研究

姚舜禹，荚卫东，王润东，葛勇胜，马金良，许戈良   

  1. 安徽医科大学附属省立医院肝脏外科  肝胆胰外科安徽省重点实验室，安徽合肥230001
  • 出版日期:2018-04-01 发布日期:2018-03-30

  • Online:2018-04-01 Published:2018-03-30

摘要：

目的    评价吲哚菁绿（ICG）荧光融合影像（FIGFI）在引导精准右半肝切除治疗肝细胞癌（HCC）中的临床价值。方法    回顾性分析2017年7月至2018年1月收治的11例行FIGFI引导精准右半肝切除治疗HCC病人的临床资料。术中经门静脉右支或外周静脉注射ICG，行正显示法或反显示法三维显影半肝行精准右半肝切除。结果    11例病人中10例（90.9%）术中肝脏显影成功，在FIGFI引导下完成精准右半肝切除，行反显示法8例，行正显示法3例，其中反显示法失败1例。10例病人肝表面ICG荧光范围均与缺血线一致，术后断面均清晰分界，11例病人手术时间为246（150～345）min，术中出血量为241（100～600）mL，所有病人术中均未输血，术后住院时间为10.4（6～15）d，术后峰值丙氨酸氨基转移酶为346（114～707）U/L，总胆红素为47.1（21.5～68.0）μmol/L，术后并发症发生率为36.4%（4/11），术后病理学检查提示11例病人均为肝细胞癌、切缘阴性，其中8例存在微血管侵犯。11例病人随访3.9（1～7）个月，其中1例病人术后2个月出现肺转移，无病人死亡。结论    FIGFI可以实时引导解剖性右半肝切除治疗HCC，有助于提高右半肝切除治疗HCC的精准度，有良好的应用前景。

关键词: 吲哚菁绿, 荧光融合影像, 肝细胞癌, 精准右半肝切除

Abstract:

Precise right hemihepatectomy for the treatment of hepatocellular carcinoma guided by fusion ICG fluorescence imaging: A clinical analysis of 11 patients        YAO Shun-yu，JIA Wei-dong，WANG Run-dong，et al. Department of Hepatic Surgery，Anhui Provincial Hospital Affiliated to Anhui Medical University; Key Laboratory of Hepatopancreatobiliary Surgery of Anhui Province，Hefei 230001，China
Corresponding author：JIA Wei-dong，E-mail：jwd1968@sina.com
Abstract    Objective    To evaluate the clinical value of fusion indocyanine green (ICG) fluorescence imaging in precise right hemihepatectomy for the treatment of hepatocellular carcinoma（HCC）. Methods    The clinical data of 11 patients with HCC who underwent precise right hemihepatectomy guided by fusion ICG fluorescence imaging (IGFI) from July 2017 to December 2017 were retrospectively analyzed. Injecting ICG in right portal vein or peripheral vein in surgery，positive staining or negative staining，attained three-dimensional staining of the half liver for precise right hemihepatectomy. Results    Ten of the 11 patients (90.9%) had successful staining who underwent precise right hemihepatectomy guided by FIGFI. The negative stainings were applied to 8 patients，including 1 failed staining，and the positive stainings were applied to 3 patients. ICG fluorescence range of 10 patients in liver surface were consistent with the ischemic line，whose postoperative liver cross-section are clearly demarcation. The mean operation time，blood loss，postoperative hospital stay，cases of blood transfusion，complication rate，postoperative peak volume of ALT and TB and complication rate were 246（150-345）min，241（100-600）mL，10.4（6-15）d，0，4/11，346（114-707）U/L and 47.1（21.5-68.0）μmol/L. Pathology results of all patients are HCC and negative margins，and microvascular invasion occurred in 8 patients. The average follow-up time of 11 patients was 3.9 months (1-7 months) without death，and pulmonary metastasis was found in 1 patient 2 months later after surgery. Conclusion    FIGFI can guide the anatomical right hepatectomy in real time， increase radical rate，accuracy and safety of right hemihepatectomy for the treatment of HCC，and has a promising prospect.

Key words: indocyanine, green fluorescence imaging, hepatocellular carcinoma, precise right hemihepatectomy