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) ›› 2022, Vol. 15 ›› Issue (02): 110 -114. doi: 10.3877/cma.j.issn.1674-6899.2022.02.010

短篇论著 上一篇    

吲哚菁绿荧光实时导航达芬奇Xi机器人肝切除术初步探讨
李宁1, 杨真诚1, 李祥1, 苗心雨1, 陈雪健1, 王伟1, 徐力善1,()   
  1. 1. 150001 哈尔滨医科大学附属第四医院肿瘤外科肝胆外科
  • 收稿日期:2022-01-18 出版日期:2022-04-30
  • 通信作者: 徐力善
  • 基金资助:
    哈尔滨医科大学附属第四医院火炬计划(HYDSYHJ201903)

A preliminary study on real-time navigation of indocyanine green Xi da Vinci robot hepatectomy

Ning Li1, Zhencheng Yang1, Xiang Li1, Xinyu Miao1, Xuejian Chen1, Wei Wang1, Lishan Xu1,()   

  1. 1. Department of Hepatobiliary Surgery and Oncology Surgery, Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, China
  • Received:2022-01-18 Published:2022-04-30
  • Corresponding author: Lishan Xu
目的

总结达芬奇Xi机器人联合吲哚菁绿荧光定位肝脏肿瘤实现精准肝切除的经验。

方法

回顾分析2021年1~5月期间20例吲哚菁绿荧光定位联合达芬奇Xi机器人肝肿瘤切除术患者的临床资料。

结果

20例均在达芬奇Xi机器人下完成肝肿瘤切除,无中转开腹,手术时间85 min(70~105 min),术中出血量110 ml(50~200 ml ),术后住院时间7 d(5~9 d)。术后患者肝功能恢复良好,均未出现出血、胆漏等并发症。术后病理结果:肝细胞肝癌10例、肝细胞异型增生和胆管异形增生1例、胆管细胞癌6例、肝硬化伴肝脏炎性改变1例、腺癌(胃肠道转移)2例。20例均为R0切除,愈合良好出院。

结论

在熟练完成腹腔镜肝肿瘤切除术的基础上,开展吲哚菁绿荧光定位联合达芬奇Xi机器人手术系统精准肝切除是安全、可行的,具有较高的临床价值及推广意义。

Objective

To summarize the experience of precision liver resection by da Vinci Xi robot combined with indocyanine green fluorescence localization for liver tumor.

Methods

The clinical data of 20 patients with liver tumor resection by indocyanine green fluorescence localization combined with da Vinci Xi robot from Jan. to May 2021 were retrospectively analyzed.

Results

All 20 patients underwent liver tumor resection with the da Vinci Xi robot without intermediate open abdomen, with an operative time of 85 min(70-105 min), and intraoperative bleeding of 110 ml(50-200 ml). Postoperative hospital stay 7 d(5-9 d). The patients recovered well from postoperative liver function, and none of them had complications such as bleeding or bile leakage. The postoperative pathological results were: 10 cases of hepatocellular cancer, 1 case of hepatocellular heterogeneous hyperplasia and bile duct heterogeneous hyperplasia, 6 cases of bile duct cell carcinoma, 1 case of cirrhosis with inflammatory changes in the liver, and 2 cases of adenocarcinoma(gastrointestinal metastasis). 20 patients were resected with R0 and discharged with good healing.

Conclusions

Based on the skillful completion of laparoscopic liver tumor resection, it is safe and feasible to carry out accurate liver resection with indocyanine green fluorescence localization combined with da Vinci Xi robotic surgical system, which has high clinical value and promotion significance.

图1 两例肝肿瘤患者术前增强CT、增强核磁影像学资料注:A.增强CT动脉期;B.增强CT静脉期;C.增强CT平衡期;D.增强核磁动脉期;E.增强核磁静脉期;F.增强核磁平衡期
图2 肝肿瘤切除术布孔方式注:A.常规肝肿瘤切除术布孔方式;B.肝左外叶切除布孔方式
图3 6例肝肿瘤患者术中荧光显影和非荧光显影的对比注:A~J.术前48 h经肘正中静脉注射吲哚菁绿溶液;K、L.术中经外周静脉注射吲哚菁绿溶液
1
Akinyemiju T, Abera S, Ahmed MM, et al. The burden of primary liver cancer and underlying etiologies from 1990 to 2015 at the global, regional, and national level:results from the global burden of disease study 2015 [J]. JAMA Oncol, 2017, 3(12):1683-1691.
2
刘荣,胡明根.腹腔镜解剖性肝切除若干问题的探讨:中国人民解放军总医院10年经验[J/CD].中华腔镜外科杂志(电子版)20103(6):466-473.
3
Viganò L, Tayar C, Laurent A, et al. Laparoscopic liver resection: a systematic review [J]. J Hepatobiliary Pancreat Surg, 2009, 16(4):410-421.
4
黄志强.微创外科——不断发展的技术与理念[J].中国实用外科杂志201030(3):161-163.
5
Guyer DR, Puliafito CA, Monés J, et al. Digital indocyanine-green angiography in chorioretinal disorders [J]. Ophthalmology, 1992, 99(2):287-291.
6
Kusano M, Tajima Y, Yamazaki K, et al. Sentinel node mapping guided by indocyanine green fluorescence imaging: a new method for sentinel node navigation surgery in gastrointestinal cancer [J]. Dig Surg, 2008, 25(2):103-108.
7
Kitai T, Inomoto T, Miwa M, et al. Fluorescence navigation with indocyanine green for detecting sentinel lymph nodes in breast cancer [J]. Breast Cancer, 2005, 12(3):211-215.
8
Ogata F, Azuma R, Kikuchi M, et al. Novel lymphography using indocyanine green dye for near-infrared fluorescence labeling [J]. Ann Plast Surg, 2007, 58(6): 652-655.
9
Raabe A, Nakaji P, Beck J, et al. Prospective evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery [J]. J Neurosurg, 2005, 103(6):982-989.
10
Rubens FD, Ruel M, Fremes SE. A new and simplified method for coronary and graft imaging during cabg [J]. Heart Surg Forum, 2002, 5(2):141-144.
11
Efanov M, Alikhanov R, Tsvirkun V, et al. Comparative analysis of learning curve in complex robot-assisted and laparoscopic liver resection [J]. HPB (Oxford), 2017, 19(9):818-824.
12
Ishizawa T, Fukushima N, Shibahara J, et al. Real-time identification of liver cancers by using indocyanine green fluorescent imaging [J]. Cancer, 2009, 115(11): 2491-2504.
13
Gotoh K, Yamada T, Ishikawa O, et al. A novel image-guided surgery of hepatocellular carcinoma by indocyanine green fluorescence imaging navigation [J]. J Surg Oncol, 2009, 100(1):75-79.
14
廖敏学,彭勇.手术机器人在肝胆胰外科的应用现状与展望[J].西部医学201830(7):1073-1078.
15
Wakabayashi G, Cherqui D, Geller D, et al. Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in morioka [J]. Ann Surg, 2015, 261(4):619-629.
16
Qiu J, Chen S, Chengyou D. A systematic review of robotic-assisted liver resection and meta-analysis of robotic versus laparoscopic hepatectomy for hepatic neoplasms [J]. Surg Endosc, 2016, 30(3):862-875.
17
Hu L, Yao L, Li X, et al. Effectiveness and safety of robotic-assisted versus laparoscopic hepatectomy for liver neoplasms: a meta-analysis of retrospective studies [J]. Asian J Surg, 2018, 41(5):401-416.
18
任昊桢,汤宁,王帅,等.机器人肝切除术与腹腔镜肝切除术治疗结直肠癌肝转移的对比研究[J].肝胆胰外科杂志202133(2):70-74.
19
Zhou Y, Lin Y, Jin H, et al. Real-time navigation guidance using fusion indocyanine green fluorescence imaging in laparoscopic non-anatomical hepatectomy of hepatocellular carcinomas at segments 6, 7, or 8 (with videos) [J]. Med Sci Monit2019, 25: 1512-1517.
20
邹雄峰,石宁,阮诗烨,等.吲哚菁绿分子荧光成像技术在腹腔镜肝切除中的应用[J].腹部外科202033(3):174-179.
[1] 许佳怡, 刘洋, 鲁鑫, 杨琴. 机器人和腹腔镜胰十二指肠切除术疗效对比探究[J]. 中华普通外科学文献(电子版), 2022, 16(02): 131-134.
[2] 蓝伟锋, 陈志坚, 洪汉崟, 陈剑伟, 黄兴华, 池小斌, 陈永标. 吲哚菁绿在腹腔镜肝切除中的应用[J]. 中华普通外科学文献(电子版), 2021, 15(04): 309-312.
[3] 徐靖. 腹腔镜下低位直肠癌前切除术[J]. 中华普外科手术学杂志(电子版), 2022, 16(01): 20-20.
[4] 佟贵繁, 汤东, 王道荣. 达芬奇机器人手术系统远端胃癌根治术的近期临床疗效[J]. 中华普外科手术学杂志(电子版), 2021, 15(05): 517-520.
[5] 唐卫东, 邓杰文, 姜超, 杨秀林, 陈霞. 86例肝门部胆管癌的解剖学观察及三维重建联合ICG分子荧光成像技术的应用价值[J]. 中华普外科手术学杂志(电子版), 2021, 15(04): 392-395.
[6] 王喻, 梁伟聪, 高新. 荧光靶向造影剂在机器人辅助根治性前列腺切除及盆腔前哨淋巴结清扫术中的应用[J]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(05): 362-366.
[7] 张素伟, 张红燕, 宫迎迎, 谢愿, 杨林青. 机器人腹腔镜阴道恶性黑色素瘤根治术一例[J]. 中华腔镜外科杂志(电子版), 2021, 14(06): 372-374.
[8] 吴迪, 李明霞, 王铭洋, 任润玲, 高琳琳, 闫志风, 孟元光. 达芬奇机器人手术治疗老年妇科恶性肿瘤患者临床观察[J]. 中华腔镜外科杂志(电子版), 2021, 14(06): 332-337.
[9] 狐鸣, 马世勋, 杨婧, 田宏伟, 詹渭鹏, 苗长丰, 房伟, 陈东东, 景武堂, 郭进, 邓渊, 黄显斌, 马云涛, 蔡辉. 吸引器在达芬奇机器人"3+2"辅助胃癌根治术中的应用体会[J]. 中华腔镜外科杂志(电子版), 2021, 14(05): 260-264.
[10] 吴迪, 闫志风, 佘宇佳, 张妮娜, 孟元光. 达芬奇机器人系统在超重肥胖妇科恶性肿瘤患者治疗中的优势分析[J]. 中华腔镜外科杂志(电子版), 2021, 14(04): 206-210.
[11] 苏英杰, 窦磊, 田东立, 芦恩婷, 张颐. 全脏器反位患者机器人辅助下宫颈癌根治术一例[J]. 中华腔镜外科杂志(电子版), 2021, 14(04): 245-247.
[12] 鞠后琼, 刘东宁, 仲崇晗, 何鹏辉, 叶善平, 王大强, 李太原. 机器人腹部无辅助切口经直肠取出标本的右半结肠合并中位直肠癌根治术(附视频)[J]. 中华结直肠疾病电子杂志, 2022, 11(02): 172-176.
[13] 王大强, 朱伟群, 刘东宁, 仲崇晗, 鞠后琼, 李太原. 体外离断直肠在NOSES Ⅰ式低位直肠癌根治术中的应用(附六例报告)[J]. 中华结直肠疾病电子杂志, 2022, 11(01): 86-88.
[14] 陈立华, 夏勇, 徐如祥. 术中荧光在神经肿瘤手术中的临床应用[J]. 中华神经创伤外科电子杂志, 2022, 08(02): 111-116.
[15] 张建锋, 于淼, 王光林, 胡旭华, 马洪庆, 李保坤, 高相鑫, 张振亚, 于滨, 王贵英. 基于加速康复外科理念达芬奇机器人辅助结直肠癌根治术患者近期疗效分析[J]. 中华临床医师杂志(电子版), 2021, 15(11): 842-847.
阅读次数
全文


摘要