Abstract:

Safety and feasibility analysis of ICG fluorescence imaging laparoscopic anatomical right hepatectomy in the treatment of liver neoplasms        LIU Sheng ,YIN Xin-min ,LIU Yi, et al. Department of Hepatobiliary Minimally Invasive Surgery，the People's Hospital of Hunan Province， Changsha 410005，China
Corresponding author：YIN Xin-min，E-mail：13319587618@163.com
Abstract  Objective  To explore the safety and feasibility of ICG fluorescence fusion technique in the treatment of liver neoplasms by laparoscopic anatomical right hepatectomy. Methods A retrospective study was conducted to enroll 108 patients with hepatic malignancies admitted to the Department of Hepatobiliary Surgery in the People's Hospital of Hunan Province from January 2016 to December 2018.The clinical data of the patients were collected. The patient's residual liver volume was calculated before surgery，and a liver function reserve test was performed to evaluate the patient's tolerance to laparoscopic right hepatectomy. According to whether indocyanine green fusion imaging technique was performed during intraoperative laparoscopic surgery，all patients were divided into two groups：fluorescent laparoscopic anatomical right hepatic group （experimental group） and non-fluorescent laparoscopic anatomical right hepatectomy group （control group）. Intraoperative and postoperative clinical data of patients in both groups were compared and analyzed. Data were reported in the form of mean ± standard deviation for numerical variables and n （%） for categorical variables. Results  There were 108 patients undergoing laparoscopic anatomical right hepatectomy，including 24 patients in the experimental group and 84 patients in the control group.  Three patients stained failed in the experimental group，of which 1 patient failed for forward staining method and 2 patients failed for reverse staining method. Intraoperatively，compared with the control group，the operation time of the experimental group［（274.58±42.12） min vs.（303.99±54.67） min，(P＜0.05）］ and hepatic occlusion time［（52.71±9.09） min vs.（59.58±11.56） min，(P＜0.05）］ were shorter，which were statistically significant；while intraoperative blood loss［（305.42±74.07） mL vs.（317.86±165.49） mL，（P＞0.05）］ had no significant difference between the two groups. Postoperatively，there was no significant difference in hospitalization time，tumor diameter and the incidence of lung infection，hemorrhage and bile leakage between the two groups （P＞0.05）. Conclusion  ICG fluorescence imaging laparoscopic anatomical right hepatectomy is helpful for the confirmation of intraoperative hepatic plane，thus reducing the operation time and hepatic occlusion time. It can be used for the detection of intraoperative bile leakage. The development of ICG fluorescence fusion technology is conducive to the promotion of laparoscopic anatomical right hepatectomy. Under strict conditions，it can effectively improve the controllability and safety of laparoscopic anatomical right hepatectomy.

Key words: liver , neoplasms；laparoscopy；anatomical hepatectomy；indocyanine green fusion , imaging

摘要：

目的    探讨吲哚菁绿（ICG）荧光融合技术在腹腔镜解剖性右半肝切除治疗肝脏肿瘤的安全性及可行性。方法    回顾性分析2016年1月至2018年12月湖南省人民医院肝胆外科收治的108例肝脏肿瘤病人临床资料，术前计算剩余肝体积，进行肝功能储备试验，评估病人对腹腔镜右半肝切除的耐受性。根据术中是否采用荧光融合影像技术引导腹腔镜手术将所有病人分为两组：荧光腹腔镜解剖性右半肝切除组（试验组）和非荧光腹腔镜解剖性右半肝切除组（对照组），分析比较两组病人术中及术后的临床资料。对于正态分布的计量资料以均数±标准差表示，计数资料用例数或百分比表示。结果    共108例病人在腹腔镜下完成解剖性右半肝切除手术，其中实验组24例，对照组84例。试验组共3例染色失败，其中1例正染失败，2例反染失败。与对照组相比，试验组的手术时间［（274.58±42.12）min vs.（303.99±54.67）min，P＜0.05］及肝门阻断时间［（52.71±9.09）min vs.（59.58±11.56）min ，P＜0.05］更短，差异有统计学意义；术中出血量两组差异无统计学意义［（305.42±74.07）mL vs.（317.86±165.49）mL，P＞0.05］。两组病人术后住院时间、肿瘤直径、肺部感染、出血及胆漏发生率差异均无统计学意义（P＞0.05）。结论    ICG荧光显影腹腔镜解剖性右半肝切除有助于术中切肝平面的确认，从而减少手术时间及肝门阻断时间，同时可用于术中胆漏的检测。ICG荧光融合技术的发展有利于腹腔镜解剖性右半肝切除技术的推广，在严格把握适应证的情况下，能有效提高腹腔镜解剖性右半肝切除的手术效率及可控性。

关键词: 肝脏肿瘤, 腹腔镜, 解剖性肝切除, 吲哚菁绿融合显像