吲哚菁绿荧光显像在微创解剖性肺段切除术段间平面确定中的初步应用

目的:探讨吲哚菁绿荧光显像在解剖性肺段切除术段间平面确定的临床应用价值。方法:回顾性分析我科2018年采用吲哚菁绿荧光显像进行微创解剖性肺段切除术段间平面确定的6例患者临床资料，其中男性2例、女性4例，平均年龄55.0岁（43~72岁），所有患者均为肺小结节患者，术前所有患者均进行三维CT支气管血管成像，评估结节位置、靶肺段肺结构、段间平面，术中靶肺段动脉及支气管离断后，通过静脉注射吲哚菁绿，采用荧光腔镜确定靶肺段边界，并用电凝标记，观察荧光显影起始时间、荧光有效对比时间、荧光持续时间及段间平面确定时间。结果:对所有患者成功进行了吲哚菁绿荧光显像，该方法能够清晰显示靶肺段段间平面。注射吲哚菁绿后，荧光显影起始时间为14 s(10~17 s)，荧光有效对比时间为87 s(75~100 s)，荧光持续时间为240 s(190~280 s)，段间平面确定时间为46 s(37~54 s)，沿标记线处理段间平面后肺组织无明显漏气，所有患者术后均未发生持续性漏气。结论:吲哚菁绿荧光显像能够有效辅助解剖性肺段切除术中段间平面的确定，安全可行，具有临床应用价值。

Clinical application of fluorescence imaging with indocyanine green to facilitate intersegmental plane identification during minimal invasive anatomic segmentectomy

Objective:To evaluate the feasibility and efficacy of intersegmental plane identification withindocyanine green fluorescence imaging during minimal invasive anatomic segmentectomy.Methods:The clinical data of 6 cases,with pulmonary nodules underwent minimal invasive anatomical thoracoscopic segmentectomy in 2018 were analyzed retrospectively.Among the six cases,male had 2 cases,and female had 4 cases.The average age of these cases was 55.0 years (43 years~72 years).Three-dimensional computed tomography bronchography and angiography was performed to evaluate the nodules' position and segmental structures preoperatively.Intraoperatively,indocyaninegreen was injected though venous after the target segmental artery and bronchus were stapled,and then indocyanine green fluorescence along theintersegmental plane was observed using infrared thoracoscopy.The intersegmental plane between target and non-target segments was marked with electric hook.The time of first appearance of fluorescence,the duration of effective contrast,the duration of fluorescence and the time of intersegmental plane marking were recorded.Results:The fluorescence imaging with indocyanine green were successfully performed toidentify the intersegmental plane in all 6 cases in the study.After the injection of ICG,the time of first appearance of fluorescence was 14 s (10~17 s).The duration of effective contrast was 87 s (75~100 s).The duration of fluorescence was 240 s (190~280 s) and the time of intersegmental plane marking was 46 s (37~54 s).There was no obvious air leakage after dissecting the intersegment plane along the marking line intraoperatively.The average thoracic cavity drainage time was 3.8 days (3~5 days) and average hospitalization time was 4.3 days (3~6 days).There was no prolonged air leakage occurrence during the follow-up.Conclusion:Indocyanine green fluorescence imaging is safe and effectivefor intersegmental plane identification during minimal invasive anatomic segmentectomy.