摘要
目的 探讨吲哚氰绿（ICG）介导的近红外光技术在微小肝脏肿瘤识别、切缘界定和精准导航手术的价值.方法 2015年3月至9月南方医科大学珠江医院肝胆一科共收治11例微小肝脏肿瘤患者,男性5例,女性6例,年龄39 ～ 70岁,平均（55±10）岁;原发性肝癌9例,转移性肝癌2例.术中使用ICG介导的近红外光技术对肿物进行识别、边缘界定和导航手术,术后对肿瘤进行大小测量、荧光分型、病理检查.符合正态分布的计量资料通过两独立样本t检验进行统计学分析.结果 术中ICG分子荧光发现病灶15个,其中7个病灶通过肉眼观察、扪诊和ICG介导的近红外光技术均能发现;6个病灶仅通过ICG介导的近红外光技术识别,其中有4个卫星病灶在术前影像检查、术中肉眼观察、触摸均未发现;另外2例病灶虽然术前发现CT下有异常,但由于位置较深（距离肝脏表面＞1.5 cm）,肉眼观察、扪诊和ICG介导的近红外光技术检查均未能发现,切开肝实质1 cm后,ICG介导的近红外光技术识别肿瘤.15个病灶均经ICG分子荧光边界定界.切除肿瘤后,经荧光再测和病理检测,均获得了R0切缘.15个病灶分中,全荧光型7个,其中高分化肝癌5个,肝硬化结节2个;部分荧光型4个,其中中分化肝癌3个,高分化肝癌1个;环形荧光型4个,其中低分化肝癌2个,转移性肝癌2个.术前CT测量11个病灶的最大径（1.7±0.2）cm,术中ICG分子荧光测量最大径（1.7±0.3）cm,差异无统计学意义（t=-0.188,P＞0.05）.结论 ICG介导的近红外光技术在术中对微小肝脏肿瘤的识别、切缘界定、精准手术导航有重要价值.
Objective To explore the value of near-infrared technology guided by indolecyanine green（ICG） in planning resection line and real-time surgical navigation in small liver cancer.Methods From March to September 2015,11 patients with hepatic tumors received hepatectomy were treated in First Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University.There were 5 male and6 female patients with average age of （55 ± 10）years （range 39-70 years）.Among whom,there were 9cases with hepatocellular carcinoma and 2 cases with colorectal cancer.A near-infrared light camera system was used to detect the liver surfaces before resection,and to plan resection line and surgical specimens.A student＇s t test was used to compare continuous parametric variables.Results The ICG-flnorescent imaging and histological examination had been used in the 15 lesions of the 11 patients.Among the 15 lesions,7 lesions were detected by visual inspections,palpation and ICG-fluorescent imaging,6 lesions were identified only by ICG-fluorescent imaging,2 lesions were detected only by ICG-fluorescent imaging after resection.Results of pathologic examination indicated that the total fluorescent type include 5 well differentiated hepatocellular carcinoma and 2 cirrhotic nodule;the partial fluorescent type include3 moderately differentiated hepatocellular carcinomas and 1 well differentiated hepatocellular carcinomas;the rim fluorescent type included 2 liver metastatic carcinoma and 2 poorly differentiated hepatocellular carcinomas.The average diameter of the tumor size measured by CT was （1.7 ± 0.2）cm,while the average diameter measured by ICG-fluorescent imaging was （1.7 ± 0.3） cm（t =-0.188,P 〉 0.05）.Conclusion Near-infrared technology guided by ICG has important value in planning resection line and real-time surgical navigation in small liver cancer.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2016年第6期444-450,共7页
Chinese Journal of Surgery
基金
国家高技术研究发展（863）计划资助项目（2012AA021105）
国家自然科学基金重点资助项目（U1401254）
广东省重大科技专项资助项目（2012A080203013）
关键词
肝肿瘤
吲哚花青绿
肿瘤切缘界定
手术导航
Liver neoplasms
Indocyanine green
Resection margins of tumor
Surgical navigation
