中国实用外科杂志

中国实用外科杂志 ›› 2023, Vol. 43 ›› Issue (01): 108-113.DOI: 10.19538/j.cjps.issn1005-2208.2023.01.15

• 论著 • 上一篇    下一篇

三维可视化联合吲哚菁绿分子荧光影像技术在复杂性肝胆管结石诊疗中应用研究

黄振驹，胡浩宇，曾思略，曾小军，刘智豪，蔡霈霖，周    翼，杨    剑，项    楠，方驰华，曾    宁   

  1. 南方医科大学珠江医院肝胆一科，广东广州510282
  • 出版日期:2023-01-01 发布日期:2023-01-19

  • Online:2023-01-01 Published:2023-01-19

摘要： 目的    探讨三维可视化技术联合吲哚菁绿（ICG）分子荧光影像技术在复杂性肝胆管结石诊疗中的临床应用价值。方法    南方医科大学珠江医院肝胆一科2019年1月至2021年12月收治66例复杂性肝胆管结石病人，术前应用薄层CT数据构建三维可视化模型，明确脉管系统变异情况，根据血流拓扑关系进行个体化肝分段、虚拟仿真手术。术中荧光影像技术实时侦测胆总管、目标肝段分界、判断肝断面是否存在胆漏。收集手术相关数据，整理并分析。结果    术前根据三维模型分析脉管系统变异情况，发现门静脉变异6例、肝动脉变异6例、胆管变异2例，术中使用ICG分子荧光影像技术进行实时导航，术中未发生脉管、胆道系统副损伤，围手术期未出现死亡病例，手术时间（324.2±121.8）min，术中出血量97.0（50.0，145.0）mL，术后住院时间7.0（6.0，9.0）d，术后并发症Clavien-Dindo分级Ⅰ级、Ⅱ级、Ⅲ级分别为5例、6例、3例，未出现Ⅳ、Ⅴ级并发症，结石清除率96.7%。 结论   在复杂性肝胆管结石诊疗中应用三维可视化技术联合ICG分子荧光影像技术，可实现术前精准评估和术中实时导航，提高手术的精准性、安全性，减少严重并发症的发生。

关键词: 复杂性肝胆管结石, 三维可视化, 吲哚菁绿, 导航, 疗效评估

Abstract: Application of three-dimensional visualization combined with indocyanine green fluorescence imaging in the diagnosis and treatment of complicated hepatolithiasis        HUANG Zhen-ju,HU Hao-yu,ZENG Si-lue,et al. First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University,Guangzhou510282,China
Corresponding author：ZENG Ning, E-mail：chen_ning16@foxmail.com
Abstract    Objective    To explore the clinical value of three-dimensional visualization technology combined with indocyanine green (ICG) fluorescence imaging in the diagnosis and treatment of complicated hepatolithiasis. Methods From January 2019 to December 2021, 66 patients with complicated hepatolithiasis were admitted to the First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University. Prior to surgery, three-dimensional visualization models were reconstructed using thin-slice CT data to clarify the anatomical variations in the vascular system; individualized liver segmentation and virtual simulation surgery were performed according to the blood flow topology. During surgery, fluorescence imaging was used for real-time detection of the common bile duct, the demarcation line of the targeted liver segment, and the presence of bile leakage in the liver section. Surgical and postoperative data were collected, collated and analyzed. Results    Vascular variations were analyzed preoperatively according to the individualized models, and there were 6 cases of portal vein variants, 6 cases of hepatic artery variants, and 2 cases of biliary variants. Intraoperative real-time navigation was performed using ICG fluorescence imaging technology. During surgery, there were no injuries to the vascular and biliary system, and no death occurred during the perioperative period. The operation time was (324.2±121.8) min, the intraoperative blood loss was 97.0(50.0,145.0)mL, and the postoperative hospital stay was 7.0(6.0,9.0)d. There were 5 cases of Clavien-Dindo’s grade Ⅰ complications,6 cases of Clavien-Dindo’s grade Ⅱ complications, and 3 cases of Clavien-Dindo’s grade Ⅲ complications. No Clavien-Dindo’s grade Ⅳ and Ⅴ complications occurred. The stone clearance rate was 96.7%. Conclusion    The application of three-dimensional visualization technology combined with indocyanine green fluorescence imaging in the diagnosis and treatment of complicated hepatolithiasis can achieve accurate preoperative assessment and real-time intraoperative navigation, improve the precision and safety of surgery, and reduce the occurrence of serious complications.

Key words: complicated hepatolithiasis, three-dimensional visualization, indocyanine green, navigation, efficacy evaluation