吲哚菁绿荧光影像辅助下腹腔镜肝切除术的手术护理

[目的]总结腹腔镜下应用吲哚菁绿荧光融合影像(FIGFI)行肝切除的手术护理,探讨如何通过手术护士的配合,使病人手术达到最好效果。[方法]回顾分析我院43例FIGFI辅助下腹腔镜肝切除术的临床资料,总结配合要点及护理经验。[结果]43例病人均运用FIGFI实施了手术,其中41例顺利完成,2例中转开腹,术中荧光发现新可疑病灶27个,其中术后病理证实为恶性的有12个,余为良性肝硬化结节,术后病理标本切缘阳性少,手术医生及病人满意度高。[结论]FIGFI具有鉴别和导航的作用,操作方便,简单易行,手术护士在术前及术中的有效配合是该项新技术成功进行的有力保障。     

吲哚菁绿荧光显影技术在乳腺癌手术中的应用

乳腺癌已经成为全球女性发病率最高的恶性肿瘤。随着综合治疗技术的不断发展,乳腺癌患者的预后得到了较大改善,其外科治疗也从“最大耐受”逐渐转变为“最小、最有效”的治疗模式。乳腺癌的保乳及保腋窝手术是目前研究的热点,如何安全有效地进行保乳及保腋窝手术需要借助先进的辅助技术。随着荧光显影技术的发展,吲哚菁绿(indocyanine green,ICG)显影技术在肿瘤外科手术得到广泛的应用,近年来也逐渐应用到乳腺癌手术中,尤其是在乳腺癌保乳根治肿瘤定位方面及保腋窝前哨淋巴结活检(sentinel lymph node biopsy,SLNB)中发挥了一定的优势,取得了较好的疗效。     

吲哚菁绿荧光导航技术应用于前哨淋巴结的临床价值

目的分析吲哚菁绿荧光导航技术应用于前哨淋巴结的临床价值。方法选取98例早期乳腺癌患者均分为两组,实验组采用吲哚菁绿荧光导航技术进行前哨淋巴结活检,对照组采用亚甲蓝染料标记追踪进行前哨淋巴结活检。比较两组患者SLN检出数目、成功率、真阳性率和假阴性率。结果两组SLNs检出数目、成功率、真阳性率和假阴性率比较差异均有统计学意义(P均<0.05)。实验组有4例发生不良反应。结论吲哚菁绿荧光导航技术应用于前哨淋巴结活检,具有定位准确、灵敏性高等优势,能较准确预测乳腺癌患者腋窝淋巴结的状态,但存在较为轻微的不良反应,值得临床推广研究。     

腹腔镜与开腹手术治疗早期子宫内膜癌临床疗效分析

目的比较腹腔镜与开腹手术治疗早期子宫内膜癌的临床价值。方法回顾性分析我院2011年6月～2012年8月74例早期子宫内膜癌病例,其中腹腔镜组24例,开腹手术组50例,对比分析两组临床效果。结果两组中年龄、绝经情况、体重指数、FIGO分期、清扫淋巴结数、术后体温、术后排气时间、留置尿管时间、术后并发症方面无统计学差异;手术时间、术中出血、抗生素使用时间、术后住院时间方面有统计学差异。结论腹腔镜治疗早期子宫内膜癌疗效肯定,安全可行,优势在于出血量少、住院时间短、使用抗生素时间短。随着患者对生活质量要求的提高、经济发展对医疗卫生投入的增多、器械设备的改进,腹腔镜手术有望替代开腹手术,成为所有早期子宫内膜癌患者的手术方式。     

腹腔镜手术治疗早期老年子宫内膜癌的疗效观察

目的研究腹腔镜手术治疗早期老年子宫内膜癌的临床疗效。方法选取2012年5月~2013年6月我院妇科收治的老年子宫内膜癌早期患者120例,随机将其分成观察组与对照组各60例,观察组患者采用腹腔镜手术,对照组患者采用传统手术,比较两组临床疗效。结果观察组的术中出血量、手术时间均少于对照组,差异有统计学意义(P<0.05);观察组患者的住院时间、体温恢复时间均短于对照组,差异有统计学意义(P<0.05);术后并发症两组相比,差异无统计学意义(P>0.05)。结论在治疗早期老年子宫内膜癌方面,应用腹腔镜手术具有手术时间短、出血量少、安全性高等优点,具有较高的临床应用价值。     

腹腔镜手术治疗宫颈癌、子宫内膜癌的近期疗效分析

目的 探讨腹腔镜手术治疗早期宫颈癌、子宫内膜癌的可行性、安全性及近期疗效.方法 回顾性分析在新疆医科大学附属肿瘤医院妇一科行腹腔镜下宫颈癌根治术102例和子宫内膜癌根治术60例患者的临床资料,并在手术时间、出血量、术后通气时间、淋巴结清扫个数及术后并发症等各方面指标与同期行开腹宫颈癌根治术54例和子宫内膜癌根治术24例的病例进行比较.结果 102例宫颈癌,60例子宫内膜癌腹腔镜手术均顺利完成,无中转开腹病例,与78例开腹手术相比,手术时间及切除的淋巴结个数相当、术中出血少、肛门排气早、术后病率低,无严重并发症发生.结论 腹腔镜手术治疗子宫恶性肿瘤安全、可行,有广泛开展的价值.     

静脉注射吲哚菁绿荧光显影法与改良膨胀萎陷法形成的段间平面界线的比较研究

目的 研究静脉注射吲哚菁绿(ICG)荧光显影法与改良膨胀萎陷法形成的段间平面的一致性.方法 回顾性分析2018年8月—2020年11月进行的20例胸腔镜下肺段切除手术,术中离断靶段动静脉和支气管后应用静脉注射ICG荧光显影,显示并标记段间平面界线,再使用改良膨胀萎陷法形成段间平面界线,判断两者显示的段间平面界线是否一致...     

两种不同浓度吲哚菁绿应用于成熟期白内障手术的对比研究

目的 在成熟期白内障手术的撕囊环节进行两种不同浓度吲哚菁绿前囊膜染色的效果和安全性比较。方法 选取武汉大学附属爱尔眼科医院2020年6月至2021年6月成熟期白内障患者56例（56眼）,通过序列生成方法随机分为0.5%吲哚菁绿染色组和0.1%吲哚菁绿染色组,各28例28眼。两组在手术中分别使用0.5%吲哚菁绿或0.1%吲哚菁绿0.2ml注入前房,在前房内留存30s后彻底冲洗,后进行白内障连续环形撕囊（continuous curvilineal capsulorrhexis,CCC）。术中观察前囊膜染色状态、CCC撕囊成功率、晶状体后囊破裂发生情况及人工晶体囊袋内置入完成情况。术后观察染色后30min染色残留情况,角膜内皮细胞丢失率及眼前房炎性反应。结果 术中前囊膜染色情况、连续环形撕囊成功率、后囊破裂发生情况、人工晶体囊袋内置入率,两组比较差异无显著性（P>0.05）。0.5%吲哚菁绿染色组较0.1%吲哚菁绿染色组染色后30min主切口及前囊膜染色残留更明显,术后角膜内皮细胞丢失率、术后眼前房炎性反应,两组比较差异无显著性（P>0.05）。结论 0.1%吲哚菁绿囊膜与0....     

腹腔镜与开腹手术治疗早期子宫内膜癌的临床对比分析

目的：探讨早期子宫内膜癌（ endometrial carcinoma ,EC）腹腔镜分期手术与传统开腹手术的临床疗效及应用价值。方法华西第二医院妇产科2010年1月至2012年12月收治256例早期EC手术患者,手术病理分期为IA～II期。其中腹腔镜分期手术152例（腹腔镜组）,开腹分期手术104例（开腹组）,对比分析两组术中术后情况。结果两组患者手术时间、术中清扫淋巴结数目及术后导尿管留置时间差异均无统计学意义（ P＞0.05）;而腹腔镜组术中出血量、盆腹腔引流量、术后镇痛药物使用率、肛门排气时间、术后住院时间及术后并发症发生率均明显少于开腹组,差异有统计学意义（ P＜0.05）。结论腹腔镜手术相较于开腹手术具有微创价值,是治疗早期EC有效、可行的术式。     

Altemeier perineal rectosigmoidectomy with indocyanine green fluorescence imaging for a female adolescent with complete rectal prolapse: A case report

BACKGROUNDRectal prolapse in young women is rare. Although laparoscopic ventral mesh rectopexy is the standard procedure because of its lower recurrence rate, postoperative infertility is a concern. Perineal rectosigmoidectomy (Altemeier procedure) is useful for these patients. However, the risk of anastomotic leakage should be considered. Recently, the usefulness of fluorescence imaging with indocyanine green (ICG) to prevent anastomotic leakage was reported. We report a case of an adolescent woman with complete rectal prolapse who underwent ICG fluorescence imaging-assisted Altemeier rectosigmoidectomy.CASE SUMMARYA 17-year-old woman who had a mental disorder was admitted to our hospital for treatment for water intoxication. The patient also suffered from rectal prolapse, approximately 3 mo before admission. She was referred to our surgical department because recurrent rectal prolapse could worsen her psychiatric disorder. Approximately 10 cm of complete rectal prolapse was observed. However, the mean maximum anal resting and constriction pressures were within normal limits on anorectal manometry. Because she had the desire to bear children in the future, she underwent Altemeier perineal rectosigmoidectomy to prevent surgery-related infertility. We performed ICG fluorescence imaging at the same time as surgery to reduce the risk of anastomotic leakage. Her postoperative course was uneventful, and the rectal prolapse was completely resolved. She continued to do well 18 mo after surgery, without recurrence of the rectal prolapse. CONCLUSIONICG fluorescence imaging-assisted Altemeier perineal rectosigmoidectomy is useful in preventing postoperative anastomotic leakage in young as well as elderly patients.     

Usefulness of indocyanine green fluorescence imaging: A case of laparoscopic distal gastrectomy after distal pancreatectomy with splenectomy

Safe preservation of the remnant stomach during distal gastrectomy in patients who have undergone distal pancreatectomy is important. During distal pancreatectomy, the splenic artery that supplies arterial blood to the cardiac part of stomach is resected. Previous reports suggested that blood flow to the remnant stomach may be insufficient when supplied by only the left inferior phrenic artery. In the present case, a 79‐year‐old woman who underwent distal pancreatectomy with splenectomy 20 years before she was diagnosed with gastric cancer and referred to our hospital. We performed laparoscopic distal gastrectomy and Roux‐en‐Y reconstruction because preoperative CT scan indicated a developed left inferior phrenic artery. To evaluate the blood supply, we employed indocyanine green fluorescence and were able to safely preserve the remnant stomach. Our experience suggests that indocyanine green fluorescence is potentially useful for evaluating blood flow to the remnant stomach.     

吲哚菁绿近红外光成像系统在非小细胞肺癌术中探寻前哨淋巴结的临床应用研究

目的：研究应用吲哚菁绿（ICG）近红外光成像系统术中探寻非小细胞肺癌（NSCLC）前哨淋巴结（SLN）的可行性及其判断区域淋巴结转移情况的准确性。方法17例cⅠa～cⅡa 期NSCLC患者,术中癌周围注射ICG 15 min后,行SLN检测,近红外光成像系统作用下发光淋巴结定义为SLN,并行肺叶切除及标准的系统性淋巴结清扫术,所有淋巴结送病理学检查。结果共14例患者成功识别SLN,SLN的识别率、假阴性率分别为82.4%和0,与染色法和核素法相比,有较高的识别率和较低的假阴性率。结论应用吲哚菁绿近红外光成像系统术中探寻早期 NSCLC 前哨淋巴结是一种安全可行的有效的判断区域淋巴结状态的方法。     

Intra-abdominal desmoid-type fibromatosis successfully resected using laparoscopic fluorescence imaging with indocyanine green after intersphincteric resection for rectal cancer

Successful resection of intra-abdominal tumors using indocyanine green (ICG) fluorescence imaging has not been reported. Here, we report a rare case of an intra-abdominal desmoid-type fibromatosis successfully resected using this technique after intersphincteric resection (ISR) for rectal cancer. One year after ISR for rectal cancer in a 47-year-old man, computed tomography showed a 50-mm intra-abdominal tumor near the left common iliac vein. Surgical resection was performed. The tumor was located in the mesentery of the remnant rectum after ISR. ICG fluorescence imaging confirmed the blood supply to the mesentery of the distal remnant rectum after tumor excision. The anal canal was successfully preserved without creating a permanent colostomy. The tumor was safely resected with resection margins, diagnosed as desmoid-type fibromatosis. No tumor recurrence was observed 6 months post-resection. This was the first case report to demonstrate the utility of this technique for an intra-abdominal tumor resection.     

吲哚菁绿清除试验在肝癌治疗中的应用进展

肝癌是一种严重威胁人类健康的疾病,肝癌治疗前需要进行肝储备功能评估,但由于肝结构与功能的复杂性,目前尚无可全面评估肝功能的方法,吲哚菁绿清除试验作为一种能够动态地、迅速地评估肝储备功能的方法被广泛应用于肝癌治疗中肝储备功能评估。本文分析归纳了吲哚菁绿清除试验在肝癌治疗肝储备功能评估中的应用,得出吲哚青绿清除试验在肝癌治疗尤其在肝切除术时能够准确评估肝储备功能,预测术后肝功能不全。     

Hepatectomy guided by indocyanine green fluorescent imaging for visualizing bile leakage (with video)

Using indocyanine green (ICG), a standard reagent used in liver function tests, bile leaks from exfoliated liver sections can be detected with higher sensitivity than naked‐eye observation. This presentation will introduce the technique of using ICG to detect bile leaks that cannot be detected by the naked eye.     

Application of near-infrared fluorescent cholangiography using indocyanine green in laparoscopic cholecystectomy

ObjectiveNear-infrared fluorescence cholangiography (NIRF-C) can help to identify the bile duct during laparoscopic cholecystectomy. This retrospective study was performed to investigate the effect of NIRF-C in laparoscopic cholecystectomy.MethodsConsecutive patients who underwent NIRF-C-assisted laparoscopic cholecystectomy (n = 34) or conventional laparoscopic cholecystectomy (n = 36) were enrolled in this study. Identification of biliary structures, the operation time, intraoperative blood loss, and postoperative complications were analyzed.ResultsLaparoscopic cholecystectomy was completed in all patients without conversion to laparotomy. The median operation time and intraoperative blood loss were not significantly different between the two groups. No intraoperative injuries or postoperative complications occurred in either group. In the NIRF-C group, the visualization rate of the cystic duct, common bile duct, and common hepatic duct prior to dissection was 91%, 79%, and 53%, respectively. The success rate of cholangiography was 100% in the NIRF-C group. NIRF-C was more effective for visualizing biliary structures in patients with a BMI of <25 than >25 kg/m².ConclusionsNIRF-C is a safe and effective technique that enables real-time identification of the biliary anatomy during laparoscopic cholecystectomy. NIRF-C helps to improve the efficiency of dissection.     

Dynamic fluorescent imaging with indocyanine green for monitoring the therapeutic effects of photoimmunotherapy

A new type of monoclonal antibody (mAb)‐based, highly specific phototherapy (photoimmunotherapy; PIT) that uses a near‐infrared (NIR) phthalocyanine dye, IRDye700DX (IR700) conjugated with an mAb, has recently been described. NIR light exposure leads to immediate, target‐selective necrotic cell death. However, tumor shrinkage takes several days to occur, making it difficult to detect earlier changes in the tumor. In this study, Panitumumab targeting the epidermal growth factor receptor (EGFR1) conjugated to IR700 was used to treat EGFR‐expressing A431 tumor cells and in vivo xenografts. PIT was performed at varying doses of NIR light (10, 30, 50 and 100 J cm^?2) in xenograft tumors in mice. Indocyanine green (ICG) dynamic imaging was evaluated for monitoring cytotoxic effects for the first hour after PIT. Our results demonstrated a statistical difference (p < 0.05) in ICG intensity between control and PIT treated tumors in the higher light exposure groups (50 J cm^?2: 2.94 ± 0.35 vs 5.22 ± 0.92, p = 0.02; and 100 J cm^?2: 3.56 ± 0.96 vs 5.71 ± 1.43, p = 0.008) as early as 20 min post ICG injection. However, no significant difference (p > 0.05) in ICG intensity between control and PIT treated tumors was evident in the lower light exposure group at any time points up to 60 min (10 J cm^?2: 1.92 ± 0.49 vs 1.71 ± 0.3, p = 0.44; and 30 J cm^?2: 1.57 ± 0.35 vs 2.75 ± 0.59, p = 0.07). Similarly, the retention index (background to corrected uptake ratio of ICG) varied with light exposure. In conclusion, ICG may serve as a potential indicator of acute cytotoxic effects of mAb‐IR700‐induced PIT even before morphological changes can be seen in targeted tumors. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.     

Lingular-segment torsion after extended left-upper division segmentectomy by video-assisted thoracic surgery with indocyanine green fluorescence imaging

Lingular-segment torsion after left-upper division segmentectomy (LUDS) is a rare complication, and the cause remains unclear. Here we report the case of a patient who developed lingular-segment torsion after LUDS for multiple lung metastases of breast cancer. One lung nodule was located in the S1 + 2 segment and another between the upper lobe and S6 on an incomplete interlobar fissure. The lung metastases were resected by extended LUDS using video-assisted thoracic surgery with indocyanine green fluorescence imaging. The staple line on the lingular segment was vertically tilted against the interlobar line because of the atypical defect of the fluorescence plane and nodule position. Chest X-ray and contrast-enhanced computed tomography indicated ischemia and torsion of the lingular segment on the second postoperative day, and completion of lingular segmentectomy was performed. This case showed the vertical intersegment staple line during LUDS was one of the important causes of postoperative torsion of the lingular segment.