您的位置：山东大学 -> 科技期刊社 -> 《山东大学学报（医学版）》

山东大学学报 (医学版) ›› 2022, Vol. 60 ›› Issue (3): 83-88.doi: 10.6040/j.issn.1671-7554.0.2021.0996

• • 上一篇    

三维可视化联合吲哚菁绿荧光影像技术在51例原发性肝癌腹腔镜切除术中的应用价值

李博,刘竞芳,鲍金鹏,李祥泽,秦广洋,田虎   

  • 发布日期:2022-03-09
  • 通讯作者: 田虎. E-mail:tianhu6585@163.com
  • 基金资助:
    济南市临床医学科技创新计划(201805033)

Application value of three-dimensional visualization combined with indocyanine green fluorescence technique in laparoscopic hepatectomy in the treatment of 51 patients with primary liver cancer

LI Bo, LIU Jingfang, BAO Jinpeng, LI Xiangze, QIN Guangyang, TIAN Hu   

  1. Department of General Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine Shandong University, Jinan 250014, Shandong, China
  • Published:2022-03-09

PDF (PC)

124

摘要： 目的 探讨在原发性肝癌(PLC)腹腔镜切除术中应用三维可视化联合吲哚菁绿(ICG)荧光影像技术的优势。 方法 采用回顾性病例-对照研究方法收集2019年1月至2021年1月山东大学附属山东省千佛山医院收治的105例PLC患者临床资料,其中行三维可视化联合吲哚菁绿荧光影像技术原发性肝癌腹腔镜切除术51例(观察组),行常规原发性肝癌腹腔镜切除术54例(对照组)。收集基线资料、手术时间、肝门阻断时间、输血情况、住院天数、术后病理、并发症及术后第1、3、6个月随访资料,比较两组疗效、并发症的发生情况及术后短期复发情况。 结果 观察组手术时间［225(135)vs 282.5(118)min,Z=-2.687, P=0.007］、术中肝门阻断时间［(35.9±8.5)vs(240.7±6.8)min, t=-3.183,P=0.002］均短于对照组,术中失血量［300(200)vs 363(141)mL, Z=-2.621,P=0.009］低于对照组。观察组术后并发症［5(4.8%)vs 14(13.3%),χ2=-4.600,P=0.032］、术后第1天丙氨酸氨基转移酶［332.1(131.7)vs 386.2(100.0),Z=-2.379,P=0.017］、第3天丙氨酸氨基转移酶［(227.1±76.1)vs(274.8±74.0),t=-3.257,P=0.002］、第5天丙氨酸氨基转移酶［(114.4±51.7)vs(151.1±61.0),t=-3.254,P=0.001］均低于对照组。 结论 三维可视化联合吲哚菁绿荧光影像技术在腹腔镜原发性肝癌切除术在缩短手术时间、术中肝门阻断时间,减少手术失血、术后并发症及术后肝功能损害具有优势。体现出了精准肝切除的理念。

关键词: 三维可视化, 吲哚菁绿, 原发性肝癌, 腹腔镜肝切除术

Abstract: Objective To explore the advantages of three-dimensional visualization combined with indocyanine green(ICG)fluorescence imaging in laparoscopic liver resection of primary liver cancer(PLC). Methods A retrospective case-control study was conducted to involve 105 PCL patients treated during Jan. 2019 and Jan. 2021, including 51 cases treated with laparoscopic hepatectomy combined with ICG fluorescence imaging(observation group)and 54 cases treated with conventional laparoscopic hepatectomy resection of PLC(control group). The baseline data, operation time, hilar occlusion time, blood transfusion, hospital stay, postoperative pathology, complications and follow-up data at 1st, 3rd and 6th months after operation were collected. The curative effect, incidence of complications and short-term postoperative recurrence were compared between the two groups. Results The operation time ［225(135)vs 282.5(118)min, Z=-2.687, P=0.007］ and intraoperative portal occlusion time ［(35.9±8.5)vs(240.7±6.8)min, t=-3.183, P=0.002］ were shorter in the observation group than in the control group. The intraoperative bleeding volume ［300(200)vs 363(141)mL, Z=-2.621, P=0.009］, incidence of complications ［5(4.8%)vs 14(13.3%), χ2=-4.600, P=0.032］, and level of glutamic pyruvic transaminase(ALT)on day 1 ［332.1(131.7)vs 386.2(100.0), Z=-2.379, P=0.017］, day 3 ［(227.1±76.1)vs(274.8±74.0), t=-3.257, P=0.002］ and day 5 ［(114.4±51.7)vs(151.1±61.0), t=-3.254, P=0.001］ were lower in the observation group than in the control group. Conclusion Compared to the conventional laparoscopic liver resection, three-dimensional visualization combined with ICG fluorescence imaging technique has advantages of shorter operation time and intraoperative hepatic hilar occlusion time, less operative bleeding and liver function damage, and fewer postoperative complications, which best embodies the concept of precise hepatectomy.

Key words: Three-dimensional visualization, Indocyanine green, Primary liver cancer, Laparoscopic hepatectomy

中图分类号: 

  • R735.7
[1] Sia D, Villanueva A, Friedman SL, et al. Liver cancer cell of origin, molecular class, and effects on patient prognosis [J]. Gastroenterology, 2017, 152(4): 745-761.
[2] Huang H, Han Y, Zhang C, et al. HNRNPC as a candidate biomarker for chemoresistance in gastric cancer [J]. Tumour Biol, 2016, 37(3): 3527-3534.
[3] Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015 [J]. CA Cancer J Clin, 2016, 66(2): 115-132.
[4] 张成武. 腹腔镜解剖性肝切除术的若干进展[J]. 肝胆胰外科杂志, 2020, 32(3): 129-132.
[5] Reich H, McGlynn F, DeCaprio J, et al. Laparoscopic excision of benign liver lesions [J]. Obstet Gynecol, 1991, 78(5 pt 2): 956-958.
[6] 鲁葆春, 杨建辉, 唐海军, 等. 吲哚菁绿荧光实时成像联合术中超声技术在特殊部位腹腔镜肝癌切除术中的应用[J]. 肝胆胰外科杂志, 2021, 33(3): 170-172. LU Baochun, YANG Jianhui, TANG Haijun, et al. Application of indocyanine green fluorescent real-time imaging combined with intraoperative ultrasound on laparoscopic hepatectomy for special surgical sites [J]. Journal of Hepatopancreatobiliary Surgery, 2021, 33(3): 170-172.
[7] 郑宁, 牟宇波, 樊海宁, 等.吲哚菁绿荧光显像在腹腔镜解剖性肝切除术中的应用进展 [J].中国普外基础与临床杂志, 2021, 28(9): 52-955.
[8] 王宏光, 许寅喆, 陈明易, 等. 吲哚菁绿荧光融合影像引导在腹腔镜解剖性肝切除术中的应用价值[J]. 中华消化外科杂志, 2017, 16(4): 405-409. WANG Hongguang, XU Yinzhe, CHEN Mingyi, et al. Application value of fusion indocyanine green fluorescence imaging in the laparoscopic anatomical liver resection [J]. Chinese Journal of Digestive Surgery, 2017, 16(4): 405-409.
[9] 方驰华, 王晓颖, 刘允怡. 计算机辅助联合吲哚菁绿分子荧光影像技术在肝脏肿瘤诊断和手术导航中的应用指南(2019版)[J]. 中国实用外科杂志, 2019, 39(7): 1127-1140.
[10] 刘磊, 赵义军. 三维重建技术在精准肝切除中的应用进展[J]. 肝胆外科杂志, 2021, 29(1): 74-76.
[11] 达选博, 莫建涛, 黄晶晶, 等. 三维数字成像手术计划系统在精准肝切除术中的应用[J]. 中国现代普通外科进展, 2021, 24(4): 257-261. DA Xuanbo, MO Jiantao, HUANG Jingjing, et al. Application of three-dimensional digital imaging surgical planning system in precise hepatectomy [J]. Chinese Journal of Current Advances in General Surgery, 2021, 24(4): 257-261.
[12] 王天一, 朱玉峰, 孙淼, 等.三维重建联合吲哚菁绿术中导航在肝癌诊断和治疗中的应用 [J].吉林大学学报(医学版), 2021, 47(4): 1014-1021. WANG Tianyi, ZHU Yufeng, SUN Miao, et al. Application of three-dimensional reconstruction combined with indocyanine green intraoperative navigation in diagnosis and treatment of liver cancer [J]. Journal of Jilin University(Medicine Edition), 2021, 47(4): 1014-1021.
[13] 周伟平, 孙志宏, 吴孟超, 等. 经腹腔镜肝叶切除首例报道[J]. 肝胆外科杂志, 1994, 34(4): 82-85.
[14] 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.
[15] 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.
[16] Terasawa M, Ishizawa T, Mise Y, et al. Applications of fusionfluorescence imaging using indocyanine green in laparoscopic hepatectomy [J]. Surg Endosc, 2017, 31(12): 5111-8.
[17] Nishino H, Hatano E, Seo S, et al. Real-time navigation for liver surgery using projection mapping with indocyanine green fluorescence: development of the novel medical imaging projection system [J]. Ann Surg, 2018, 267(6): 1134-1140.
[18] Mise Y, Sakamoto Y, Ishizawa T, et al. A worldwide survey of the current daily practice in liver surgery [J]. Liver Cancer, 2013, 2(1): 55-66.
[19] 周伟平, 李鹏鹏. 三维可视化技术基础上的肝癌切除: 精准与个性化的结合[J]. 中国实用外科杂志, 2018, 38(4): 378-380. ZHOU Weiping, LI Pengpeng. Hepatectomy based on three-dimensional technology: combination of accuracy and personalization [J]. Chinese Journal of Practical Surgery, 2018, 38(4): 378-380.
[20] 王晓颖, 高强, 朱晓东, 等. 腹腔镜超声联合三维可视化技术引导门静脉穿刺吲哚菁绿荧光染色在精准解剖性肝段切除术中的应用[J]. 中华消化外科杂志, 2018, 17(5): 452-458. WANG Xiaoying, GAO Qiang, ZHU Xiaodong, et al. Application of ICG fluorescence staining by laparoscopic ultrasound and 3D visualization guided portal branch puncture approach in anatomical segmentectomy [J]. Chinese Journal of Digestive Surgery, 2018, 17(5): 452-458.
[21] Takamoto T, Hashimoto T, Ogata S, et al. Planning of anatomical liver segmentectomy and subsegmentectomy with 3-dimensional simulation software [J]. Am J Surg, 2013, 206(4): 530-538.
[22] Oshiro Y, Yano H, Mitani J, et al. Novel 3-dimensional virtual hepatectomy simulation combined with real-time deformation [J]. World J Gastroenterol, 2015, 21(34): 9982-9992.
[23] 曾思略, 曾宁, 祝文, 等. 三维可视化联合吲哚菁绿荧光影像技术在原发性肝癌诊治中的价值[J]. 南方医科大学学报, 2019, 39(12): 1402-1408. ZENG Silue, ZENG Ning, ZHU Wen, et al. Three-dimensional visualization combined with indocyanine green fluorescence imaging in diagnosis and treatment of primary hepatocellular carcinoma [J]. Journal of Southern Medical University, 2019, 39(12): 1402-1408.
[24] Inoue Y, Arita J, Sakamoto T, et al. Anatomical liver resections guided by 3-dimensional parenchymal staining using fusion indocyanine green fluorescence imaging [J]. Ann Surg, 2015, 262(1): 105-111.
[25] Mullock BM, Shaw LJ, Fitzharris B, et al. Sources of proteins in human bile [J]. Gut, 1985, 26(5): 500-509.
[26] Sakaguchi T, Suzuki A, Unno N, et al. Bile leak test by indocyanine green fluorescence images after hepatectomy [J]. Am J Surg, 2010, 200(1): e19-e23.
[27] Zhang YM, Shi R, Hou JC, et al. Liver tumor boundaries identified intraoperatively using real-time indocyanine green fluorescence imaging [J]. J Cancer Res Clin Oncol, 2017, 143(1): 51-58.
[28] 成剑, 张成武, 刘杰, 等. 3D打印模型联合吲哚菁绿荧光导航行腹腔镜下精准肝切除术[J]. 肝胆胰外科杂志, 2020, 32(5): 277-279. CHENG Jian, ZHANG Chengwu, LIU Jie, et al. Application of 3D printing model combined with indocyanine green fluorescence navigation in the laparoscopic precise hepatectomy [J]. Journal of Hepatopancreatobiliary Surgery, 2020, 32(5): 277-279.
[1] 张煜,唐兴,马海涛,蒋威. 荧光染色技术在胸腔镜肺段切除术中的价值[J]. 山东大学学报 (医学版), 2020, 58(12): 38-42.
[2] 窦瑞欣,薛敏娜,李国华. 基于VTK实现三维重建在胆囊管变异中的诊断价值[J]. 山东大学学报（医学版）, 2017, 55(7): 84-88.
[3] 张继宗1,2，孟九大2，丁海2，易永祥2，余泽前3，周家华3. 血清天冬氨酸-天冬酰胺β羟化酶(ASPH)分子联合AFP和GP73检测对原发性肝癌的诊断意义[J]. 山东大学学报（医学版）, 2014, 52(6): 78-80.
[4] 王旭，程宝泉，梁旭阳，贾俊英，李倩倩. 高迁移率族蛋白B1在肝癌细胞中的表达及其临床意义[J]. 山东大学学报(医学版), 2012, 50(4): 38-41.
[5] 徐晓梅1，于皎1， 李国华1，姜岩2，姜兆全3，张萍3，程晓云1. 益气补肾祛瘀法治疗肝功能失代偿的原发性肝癌的临床研究[J]. 山东大学学报(医学版), 2012, 50(12): 70-.
[6] 王晓花1，高淑春1，崔蕾2，蒋雪梅1，杜以真1. 白介素-28B在乙型肝炎病毒相关肝癌患者血清中的表达及意义[J]. 山东大学学报(医学版), 2012, 50(10): 106-110.
[7] 孔祥亘1，韩绍磊2，郑昭敏2，杜文军2，陈士俊2. 高尔基体蛋白73联合甲胎蛋白异质体在原发性肝癌诊断中的价值[J]. 山东大学学报(医学版), 2011, 49(4): 110-114.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
版权所有 © 2018 《山东大学学报(医学版)》编辑部　
地址:山东大学科技期刊社（济南市历城区山大南路27号山东大学中心校区明德楼B座721室） 电话: 0531-88366918 E-mail: xbyxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发