切换至 "中华医学电子期刊资源库"

中华腔镜外科杂志(电子版) ›› 2021, Vol. 14 ›› Issue (01) : 15 -18. doi: 10.3877/cma.j.issn.1674-6899.2021.01.004

所属专题: 文献

论著

吲哚菁绿在机器人肝脏FNH切除术中的应用
李成刚1,(), 赵之明1, 胡明根1, 谭向龙1, 张煊1, 周志鹏1, 姜楠1, 贾育泽1   
  1. 1. 100853 北京,解放军总医院肝胆胰外科医学部 肝胆外科研究所 全军数字肝胆外科重点实验室
  • 收稿日期:2020-11-25 出版日期:2021-02-28
  • 通信作者: 李成刚

Application of indocyanine green in robotic resection of liver FNH

Chenggang Li1,(), Zhiming Zhao1, Minggen Hu1, Xianglong Tan1, Xuan Zhang1, Zhipeng Zhou1, Nan Jiang1, Yuze Jia1   

  1. 1. Faculty of Hepato-Pancreato-Biliary Surgery and Institute of Hepatobiliary Surgery and Key Laboratory of Digital Hepetobiliary Surgery, the First Medical Center of PLA General Hospital, Beijing 100853, China
  • Received:2020-11-25 Published:2021-02-28
  • Corresponding author: Chenggang Li
引用本文:

李成刚, 赵之明, 胡明根, 谭向龙, 张煊, 周志鹏, 姜楠, 贾育泽. 吲哚菁绿在机器人肝脏FNH切除术中的应用[J/OL]. 中华腔镜外科杂志(电子版), 2021, 14(01): 15-18.

Chenggang Li, Zhiming Zhao, Minggen Hu, Xianglong Tan, Xuan Zhang, Zhipeng Zhou, Nan Jiang, Yuze Jia. Application of indocyanine green in robotic resection of liver FNH[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2021, 14(01): 15-18.

目的

总结应用吲哚菁绿(indocyanine green,ICG)在机器人肝脏局灶性结节性增生(focal nodular hyperplasia,FNH)切除术中荧光显影定位导航的方法。

方法

回顾性分析解放军总医院肝胆胰外科医学部2018年5月至2020年10月行ICG荧光显影术中导航机器人肝脏FNH切除患者的临床病理资料。根据肿瘤大小将患者分为肿瘤<5 cm组和肿瘤≥ 5 cm组。术前48 h,患者经肘正中静脉注射ICG,剂量0.25 mg/kg。术中在机器人荧光模式下实时定位肿瘤边界并联合应用术中超声完成FNH切除术。

结果

36例患者中,男17例、女19例,平均年龄28.7岁。35例完成机器人肿瘤切除术、1例中转开腹。肿瘤平均直径(5.9±4.4)cm,13例患者肿瘤<5 cm、23例患者肿瘤≥ 5 cm。机器人手术患者的中位手术时间120 min,中位术中出血量50 ml,术后平均住院时间3.9 d。两组的手术时间、术中出血量和术后平均住院时间比较,差异有统计学意义(P<0.05)。

结论

ICG荧光显影术中可实时显示肝脏FNH肿瘤边界,引导外科医师机器人下完整切除肿瘤。

Objective

To summarize the application of indocyanine green (ICG) in localization of tumor and determination of resection boundary in robotic resection of liver focal nodular hyperplasia (FNH).

Methods

The clinical and pathological data of patients who underwent robotic resection of liver FNH from May 2018 to Oct. 2020 were retrospectively analyzed. According to the tumor size, the patients were divided into < 5 cm and ≥ 5 cm groups. Two days before the operation, ICG was injected through the median elbow vein in all the patients at a dose of 0.25 mg/kg. The position and boundary of FNH in the liver was located by the fluorescence mode of da Vinci Si robotic surgery system and combined with intraoperative ultrasound examination when necessary.

Results

There were 36 patients in this study, including 17 males and 19 females, with an average age of 28.7 years. 35 patients completed robotic tumor resection, and 1 patient was converted to open surgery. The average diameter of tumor was (5.9 ± 4.4) cm, 13 cases were less than 5 cm, 23 cases were more than 5 cm. The median operation time of robotic resection group was 120 min, and the median blood loss was 50 ml, and the average postoperative hospital stay was 3.9 days. Compared with ≥ 5 cm group, < 5 cm group had shorter operation time and less bleeding and shorter postoperative hospital stay (P<0.05).

Conclusions

ICG fluorescence imaging can display the FNH tumor boundary in real time, and guide the surgeon to perform radical resection of tumor by robotic surgery system.

图1 ICG荧光显影术中导航机器人肝脏FNH切除术
表1 35例机器人手术切除患者围手术期比较
1
王鲁平. 良性肝细胞病变的病理诊断及鉴别诊断2019年第五版WHO消化系统肿瘤关于良性肝细胞病变的更新及进展 [J]. 诊断病理学杂志,2020, 27(10): 749-753.
2
周波,韩少良,陈宗静,等. 肝脏局灶性结节增生的诊断和治疗[J]. 肝胆胰外科杂志,2020, 32(7): 419-422.
3
孙俪洋,高恒军,卢俊. 肝脏局灶性结节性增生临床诊治分析[J]. 腹部外科,2019, 32(6): 408-412.
4
Bröker MEE, Klompenhouwer AJ, Gaspersz MP, et al. Growth of focal nodular hyperplasia is not a reason for surgical intervention, but patients should be referred to a tertiary referral centre [J]. World J Surg, 2018, 42(5): 1506-1513.
5
Matsukuma KE, Yeh MM. Update on the pathology of liver neoplasms [J]. Ann Diagn Pathol, 2019, 38: 126-137. DOI: 10.1016/j.anndiagpath.2018.10.005
6
张炜彬,董怡,汪瀚韬,等. 肝脏局灶性结节性增生的超声造影与增强磁共振成像的增强表现对比研究[J]. 肿瘤影像学,2020, 29(4): 345-351.
7
邓海辉,招伟成,陈斌,等. 肝脏局灶性结节增生的影像学特点及介入治疗(附5例报告并文献复习) [J]. 罕少疾病杂志,2018, 25(3): 36-39.
8
韩红,季正标,丁红,等. 联合微血流成像及彩色多普勒血流显像在肝局灶性结节增生中的应用价值 [J]. 中华超声影像学杂志,2019,28(2): 114-117.
9
聂艳红,刘慧,陈昊. 肝局灶结节性增生11例并文献复习 [J]. 诊断病理学杂志,2019, 26(9): 612-613.
10
Reinhart MB, Huntington CR, Blair LJ, et al. Indocyanine green: historical context, current applications, and future considerations [J]. Surg Innov, 2016, 23(2): 166-175.
11
Spinoglio G, Bertani E, Borin S, et al. Green indocyanine fluorescence in robotic abdominal surgery [J]. Updates Surg, 2018, 70(3): 375-379.
12
邱华,单人锋,项灯,等. 腹腔镜肝切除术治疗肝局灶性结节性增生20例 [J]. 实用医学杂志,2017, 33(2): 333-334.
13
Perrakis A, Vassos N, Grützmann R, et al. What is changing in indications and treatment of focal nodular hyperplasia of the liver. is there any place for surgery [J] . Ann Hepatol, 2017, 16(3): 333-341.
14
Rosmalen BV, Graeff JJ, Poel MJ, et al. Impact of open and minimally invasive resection of symptomatic solid benign liver tumours on symptoms and quality of life: a systematic review [J]. HPB (Oxford) , 2019, 21(9): 1119-1130.
15
管若愚,马迪,杨奎,等. 肝脏局灶性结节增生的诊治 [J]. 外科理论与实践,2018, 23(2): 140-144.
16
毛岸荣,潘奇,赵一鸣,等. 腹腔镜肝切除术在肝脏局灶性结节性增生中的应用 [J]. 肝胆胰外科杂志,2017, 29(2): 103-106.
17
Virgilio E, Cavallini M. Managing focal nodular hyperplasia of the liver: surgery or minimally-invasive approaches: a review of the preferable treatment options [J]. Anticancer Res, 2018, 38(1): 33-36.
18
Souzaki R, Kawakubo N, Matsuura T, et al. Navigation surgery using indocyanine green fluorescent imaging for hepatoblastoma patients [J]. Pediatr Surg Int, 2019, 35(5): 551-557.
19
Yuan L, Qi X, Zhang Y, et al. Comparison of sentinel lymph node detection performances using blue dye in conjunction with indocyanine green or radioisotope in breast cancer patients: a prospective single-center randomized study [J]. Cancer Biol Med, 2018, 15(4): 452-460.
20
刘荣,赵之明. 正确认识"达芬奇"手术机器人在肝胆胰外科中的作用 [J/CD].中华腔镜外科杂志(电子版), 2012, 5(2): 83-85.
[1] 钟锴, 蒋铁民, 张瑞青, 吐尔干艾力·阿吉, 邵英梅, 郭强. 加速康复外科在肝囊型棘球蚴病肝切除术中的应用分析[J/OL]. 中华普通外科学文献(电子版), 2024, 18(06): 425-429.
[2] 王振宁, 杨康, 王得晨, 邹敏, 归明彬, 王雅楠, 徐明. 机器人与腹腔镜手术联合经自然腔道取标本对中低位直肠癌患者远期疗效比较[J/OL]. 中华普通外科学文献(电子版), 2024, 18(06): 437-442.
[3] 周世振, 朱兴亚, 袁庆港, 刘理想, 王凯, 缪骥, 丁超, 汪灏, 管文贤. 吲哚菁绿荧光成像技术在腹腔镜直肠癌侧方淋巴结清扫中的应用效果分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 44-47.
[4] 李华志, 曹广, 刘殿刚, 张雅静. 不同入路下行肝切除术治疗原发性肝细胞癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 52-55.
[5] 冯旺, 马振中, 汤林花. CT扫描三维重建在肝内胆管细胞癌腹腔镜肝切除术中的临床研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 104-107.
[6] 赖全友, 高远, 汪建林, 屈士斌, 魏丹, 彭伟. 三维重建技术结合腹腔镜精准肝切除术对肝癌患者术后CD4+、CD8+及免疫球蛋白水平的影响[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 651-654.
[7] 唐梅, 周丽, 牛岑月, 周小童, 王倩. ICG荧光导航的腹腔镜肝切除术临床意义[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 655-658.
[8] 王兴, 文阳辉, 姚戈冰, 郭平学, 杨自华. ICG荧光腹腔镜下胆囊切除术的临床应用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 663-666.
[9] 叶劲松, 刘驳强, 柳胜君, 吴浩然. 腹腔镜肝Ⅶ+Ⅷ段背侧段切除[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 315-315.
[10] 郭兵, 王万里, 何凯, 黄汉生. 腹腔镜下肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 143-143.
[11] 魏丽霞, 张安澜, 周宝勇, 李明. 腹腔镜下Ⅲb型肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 145-145.
[12] 杭轶, 杨小勇, 李文美, 薛磊. 可控性低中心静脉压技术在肝切除术中应用的最适中心静脉压[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 813-817.
[13] 焦振东, 惠鹏, 金上博. 三维可视化结合ICG显像技术在腹腔镜肝切除术治疗复发性肝癌中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 859-864.
[14] 吴警, 吐尔洪江·吐逊, 温浩. 肝切除术前肝功能评估新进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 889-893.
[15] 吴雪云, 胡小军, 范应方. 肝切除术中剩余肝再生能力的评估与预测[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 894-897.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?