吲哚菁绿在机器人小肝癌靶域切除中的应用

目的总结吲哚菁绿在机器人小肝癌(≤5 cm)靶域切除术中实时定位肿瘤和判断残余肝脏功能的方法。 方法回顾性分析2021年5月至2022年3月期间，行机器人小肝癌(≤5 cm)靶域切除患者的围手术期资料。术前48 h，经患者肘正中静脉注射吲哚菁绿，剂量0.25 mg/kg。机器人荧光模式下经吲哚菁绿荧光显影实时定位肿瘤边界，肿瘤切除完毕后，经外周静脉再次注射吲哚菁绿判断残余肝脏血供。 结果12例患者中，男10例、女2例，平均年龄56.3岁。肿瘤直径(3.3±1.09) cm，中位手术时间75 min，中位出血量50 ml，术后平均住院时间4.9 d。术中肿瘤全部呈绿色显影，荧光显影与肿瘤分化程度无关，肿瘤内部出血和坏死部分不显影。手术切缘缺血部分肝脏组织于解除肝门阻断后5 min开始出现吲哚菁绿荧光显影，所有患者术后未发生残余肝脏的缺血和坏死。 结论吲哚菁绿荧光显影可实时引导机器人小肝癌靶域切除并能实时判断残余肝脏血供。

Application of indocyanine green in robotic target resection of small hepatocellular carcinoma

ObjectiveTo summarize the methods of real-time localization of tumor and judgment of residual liver function of indocyanine green (ICG) in robotic target resection of small hepatocellular carcinoma (sHCC). MethodsThe perioperative data of patients who underwent robotic resection of sHCC (≤5 cm) from May 2021 to Mar. 2022 were retrospectively analyzed. Forty-eight hours before operation, ICG was injected through the median elbow vein in all the patients at a dose of 0.25 mg/kg. In the robot fluorescence mode, the tumor boundary was located in real time by ICG fluorescence development. After tumor resection, ICG was injected again through peripheral vein of patients to judge the residual liver blood supply. ResultsThere were 12 patients in this study, including 10 males and 2 females, with an average age of 56.3 years. The average diameter of tumor was (3.3±1.09) cm, and the median operation time was 75 min, and the median blood loss was 50 ml, and the average postoperative hospital stay was 4.9 days. During the operation, all tumors displayed green fluorescent, the fluorescent effect had nothing to do with the degree of tumor differentiation, and the internal bleeding and necrosis of the tumor did not displayed green fluorescent. ICG fluorescence imaging began to appear in the ischemic part of the liver tissue around the surgical margin 5 minutes after the removal of the hepatic portal occlusion. There was no residual liver ischemia and necrosis in all patients. ConclusionsICG fluorescence imaging can guide the robotic target resection of sHCC and judge the residual liver blood supply in real time.