吲哚菁绿近红外荧光成像在食管癌淋巴结清扫中的应用

淋巴结清扫是食管癌根治术中至关重要的部分之一。近些年食管癌外科朝着精准化、微创化和个性化方向发展,安全有效的淋巴结清扫成为外科医生追求的热点方向。由于食管淋巴系统特点以及吲哚菁绿荧光成像技术在实体恶性肿瘤中成功应用,相关技术现也逐渐应用于食管癌根治术中。在不同时期的食管癌淋巴结清扫中发挥出明显的优势,取得的良好临床应用效果。本文通过回顾既往相关研究,对吲哚菁绿近红外荧光成像技术在食管癌淋巴结清扫的应用进行阐述。     

常规低位整束结扎胸导管预防食管癌术后乳糜胸

目的 探讨常规低位结扎胸导管预防食管癌术后乳糜胸的经验和方法,方法 全组451例,男290例,女161例,年龄38-80岁之间,中位年龄60.5岁,临床病理分期,Ⅰ期21例,Ⅱa期139例,Ⅱb期110例,Ⅲ期137例,Ⅳ期24例,术中常规低位整束结扎胸导管。结果 未发现乳糜胸。结论 常规低位整束结扎胸导管预防术后乳糜胸方法简便,效果优良。     

选择性结扎胸导管预防食管癌术后乳糜胸

目的:总结食管癌术中选择性结扎胸导管预防乳糜胸的经验。方法:在285例食管癌切除术中选择性对28例于膈上5cm处将胸导管及周围组织一并大块结扎。结果:285例食管癌切除术后无乳糜胸发生。结论:采用选择性结扎胸导管安全可靠,有一定的预防食管癌术后乳糜胸的作用。     

食管癌术后乳糜胸的预防与治疗

1993年11月-1994年12月，我们手术切除食管癌300例，同期发生乳糜胸7例。其中6例食管中段癌，1例食管下段癌术后。食管癌术后乳麻糜胸的及时治疗效果非常满意。本组乳糜胸的发生率为2.3%。作乾认为，食管癌切除术后针对手术中的具体情况行胸导管的预防性结扎可以减少乳糜胸的发生；关胸前常规结扎胸导管并非必要。     

常规低位整束结扎胸导管预防食管癌术后乳糜胸

目的　探讨常规低位结扎胸导管预防食管癌术后乳糜胸的经验和方法。方法　全组 45 1例 ,男 2 90例 ,女 16 1例 ,年龄 38～ 80岁之间 ,中位年龄 6 0 5岁 ,临床病理分期 ,Ⅰ期 2 1例 ,Ⅱa期 139例 ,Ⅱb期 110例 ,Ⅲ期 137例 ,Ⅳ期 2 4例 ,术中常规低位整束结扎胸导管。结果　未发现乳糜胸。结论　常规低位整束结扎胸导管预防术后乳糜胸方法简便 ,效果优良。     

结扎胸导管预防食管癌术后乳糜胸

 作者自1988年至1990年在食管癌切除、食管—胃颈部或主动脉弓上吻合术中,常规行预防性低位、集束结扎胸导管。术后乳糜胸发生率为0.64%(3/464),比本院前期有明显下降,说明预防性胸导管结扎术能减少食管癌术后乳糜胸的发生。并着重讨论了结扎方法和结扎术后再发乳糜胸的问题。     

食管癌术后乳糜胸9例外科治疗体会

乳糜胸是胸部手术后重要并发症之一，尤其是食管癌切除术后，可致大量营养物质和淋巴细胞丧失，不仅影响呼吸功能，还可引起严重的营养代谢和免疫功能紊乱。我院从1993年5月至2004年9月共发生食管癌手术后乳糜胸9例，占同期食管癌切除术的1．1％，现将诊治体会报道如下。     

食管癌切除术后乳糜胸的防治

乳糜胸是食管癌切除术后的 1种严重并发症。我院自1989年 6月至 2 0 0 2年 6月共对 5 844例食管癌患者行手术治疗 ,术后发生乳糜胸 17例 ,现作回顾性分析 ,报告如下。1　材料与方法1.1　一般资料本组食管贲门癌切除患者共 8937例 ,食管癌 5 844例 ,病变长度 3～ 10cm ,胸导管结     

食管癌切除术中结扎胸导管预防乳糜胸

乳糜胸是食管癌切除术后最严重的并发症之一，可导致水、电解质紊乱，低蛋白血症，机体免疫功能下降或呼吸、循环系统衰竭等犤１犦。所以，对乳糜胸应积极预防。自１９８０年３月～２０００年１１月，我院共行食管癌切除术１９９５例，其中术后发生乳糜胸２１例（１．０５％），现将结果报告如下。１材料与方法１．１临床资料本组１９９５例，男１５３６例，女４５９例。年龄３２～７８岁，平均５９岁。食管中段癌１６５５例，上段癌２７例，下段癌３１３例；肿瘤病变长度３～９cm，平均５．６cm。左胸后外侧切口８２２例，左颈、右后外开胸…     

Robotic resection of liver focal nodal hyperplasia guided by indocyanine green fluorescence imaging: A preliminary analysis of 23 cases

BACKGROUNDFocal nodal hyperplasia (FNH) is a common benign tumor of the liver. It occurs mostly in people aged 40-50 years and 90% of the patients are female. FNH can be cured by local resection. How to locate and judge the tumor boundary in real time is often a challenge for surgeons.AIMTo summarize the technique and feasibility of robotic resection of FNH guided by indocyanine green (ICG) fluorescence imaging.METHODSThe demographics and perioperative outcomes of a consecutive series of patients who underwent robotic resection of liver FNH guided by ICG fluorescence imaging between May 1, 2018 and September 30, 2019 were retrospectively analyzed. ICG was injected through the median elbow vein in all the patients at a dose of 0.25 mg/kg 48 h before the operation. During the operation, the position of FNH in the liver was located in the fluorescence mode of the Da Vinci Si robot operating system and the tumor boundary was determined during the resection.RESULTSAmong the 23 patients, there were 11 males and 12 females, with a mean age of 30.5 ± 9.3 years. Twenty-two cases completed robotic resection, while one (4.3%) case converted to open surgery. In the robotic surgery group, the operation time was 35-340 min with a median of 120 min, the intraoperative bleeding was 10-800 mL with a median of 50 mL, and the postoperative hospital stay was 1-7 d with a median of 4 d. Biliary fistula occurred in two (8.7%) patients after robotic operation and they both recovered after conservative treatment. One (4.3%) patient received blood transfusion and there was no death in this study. The postoperative hospital stay in the small tumor group was significantly shorter than that in the large tumor group (P < 0.05).CONCLUSIONICG fluorescence imaging can guide the surgeon to perform robotic resection of liver FNH by locating the tumor and displaying the tumor boundary in real time. It is a safe and feasible method to ensure the complete resection of the tumor.     

Mapping of the perigastric lymphatic network using indocyanine green fluorescence imaging and tissue marking dye in clinically advanced gastric cancer

BackgroundUsing indocyanine green (ICG) fluorescence imaging and tissue marking dyes (TMDs), perigastric lymphatic mapping and their pathological correlation were examined to see whether ICG staining covers all metastatic lymph nodes (LNs) in advanced gastric cancer (AGC).MethodsPatients with AGC who underwent open distal or total gastrectomy were enrolled. ICG was serially injected intraoperatively into the subserosa along the greater and lesser curvatures. Stomach specimens were examined under a near-infrared camera. ICG-stained LNs were named, excised, and tattooed with different colored TMDs to retrace the exact location after pathological examinations.ResultsA total of 687 LNs and 69 LN stations were examined from 11 patients. The map of the perigastric lymphatic network showing the topography of ICG-stained and ICG-unstained LNs, including metastatic information, was successfully reconstructed. The average number of ICG-stained and ICG-unstained LNs were 23.6 ± 12.3 (37.8%) and 38.8 ± 17.1 (62.2%), respectively. LN metastases were present in 28 LN stations of 8 patients. Of 8 cases with LN metastases, 40% (11.1–75% per case) of metastatic LNs were stained by ICG. Of 28 metastatic LN stations, 21 (75.0%) were covered by ICG, and actual metastatic LNs were stained in 16 LN stations (57.1%). In 4/8 cases (50%), all metastatic LN stations showed ICG signals.ConclusionsICG fluorescence imaging and TMD are useful tools for visualizing the perigastric lymphatic network and retracing the exact location of ICG-stained LNs in AGC. However, ICG imaging is still not recommended for selective LN dissection in AGC because of the limited staining of perigastric LNs.     

近红外线吲哚氰绿荧光显像法在cN0口腔癌前哨淋巴结活检中的应用

目的 评价近红外线吲哚氰绿(ICG)荧光显像法在临床淋巴结阴性(cN0)口腔癌术中前哨淋巴结活检中的可行性和有效性.方法 符合条件且知情同意的cT1-3 N0 M0口腔(或口咽)癌患者30例入组.切开皮肤前用1 ml注射器抽取ICG(25 mg/5 ml)1 ml行瘤周四象限和基底注射;随后行常规颈清扫切口翻瓣游离胸锁乳突肌并将其向后牵拉,显露术野,用近红外线荧光成像系统扫描术区直至捕获荧光热点,切除热点淋巴结;离体淋巴结经再次扫描确认为荧光热点者定义为前哨淋巴结.完成颈清扫后将前哨淋巴结和非前哨淋巴结分别送病理检查.结果 全组30例均成功地获取前哨淋巴结,每例前哨淋巴结数目1～9枚,平均3.4枚.常规病理证实30例中5例(16.67％)有隐匿性转移,转移淋巴结全部为前哨淋巴结.全组未发生ICG相关的不良反应.结论 近红外线ICG荧光显像法对cN0口腔癌行术中前哨淋巴结活检成功率高,前哨淋巴结能准确评价颈淋巴结转移状况.该方法简单可行,有发展前景,值得进一步研究.     

Indocyanine green fluorescence imaging for sentinel lymph node detection in colorectal cancer: A systematic review

Indocyanine green fluorescence-imaging (ICG-FI) has emerged as a potential tool for increasing the accuracy of staging of patients with primary colorectal cancer (CRC) through the detection of sentinel lymph nodes (SLNs). Here, we report the results of a systematic review of the available literature in the clinical setting of ex vivo and in vivo ICG-FI for the detection of SLNs in primary colorectal cancer. PubMed, Scopus, and Cochrane literature databases were searched for original articles on the use of ICG in the setting of clinical studies of CRC. Eighty studies were identified and screened, 23 were assessed for eligibility and 10 were included for review. Both ex vivo and in vivo ICG-FI are reported to be feasible for the detection of SLNs in CRC. The reported sensitivity of both techniques remains low, varying from 0% to 100% for the in vivo technique and 57% for the ex vivo technique. ICG-FI has not yet been shown to perform better than the standard blue dye technique. In addition, large variability among reported studies in terms of techniques used (ICG dose, type of injection), type of pathologic analyses performed (HE, IHC, serial section), and definition of positive LN status for sensitivity calculations made them difficult to compare directly. ICG-FI is a promising technique for the detection of SLNs in the setting of CRC but more work needs to be done to clearly define protocols and indications for its use and to test its efficacy in larger patient populations.     

Enhancing colorectal anastomotic safety with indocyanine green fluorescence angiography: An update

Reducing anastomotic leak (AL) continues to be a main focus in colorectal research. Several new technologies have been developed with an aim to reduce this fluorescence angiography (FA) with indocyanine green (ICG) in colorectal surgery is now a well-established technique. By using FA we are able to have a visual representation of perfusion which aids intraoperative decision making. The main impact is change in the level of bowel transection at the proximal side of an anastomosis. Previous studies have shown that routine FA use is safe and reproducible. Recent results from randomized control trials and meta-analyses show that FA use reduces the rate of anastomotic leak. The main limitation of FA is its lack of ability to quantify perfusion. Novel technologies are being developed that will quantify tissue perfusion and oxygenation. Overall, FA is a safe technique and we would advocate its routine use.     

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。     

Axillary reverse mapping using near-infrared fluorescence imaging in invasive breast cancer (ARMONIC study)

BackgroundAxillary lymph node dissection (ALND) in patients with breast cancer has potential side effects, including upper-limb lymphedema. Axillary reverse mapping (ARM) is a technique that enables discrimination of the lymphatic drainage of the upper limb in the axillary lymph node basin from that of the breast. We aimed to evaluate ARM node identification by near-infrared (NIR) fluorescence imaging during total mastectomy with ALND and then to analyze potential predictive factors of ARM node involvement.MethodsThe study enrolled 119 patients diagnosed with invasive breast cancer with an indication for ALND. NIR imaging using indocyanine green dye was performed in 109 patients during standard ALND to identify ARM nodes and their corresponding lymphatic ducts.Results94.5% of patients had ARM nodes identified (95%CI = [88.4–98.0]). The ARM nodes were localized in zone D in 63.4% of cases. Metastatic axillary lymph nodes were found in 55% in the whole cohort, and 19.4% also had metastasis in ARM nodes. Two patients had metastatic ARM nodes but not in the remaining axillary lymph nodes. No serious adverse events were observed. Only the amount of mitosis was significantly associated with ARM node metastasis.ConclusionsARM by NIR fluorescence imaging could be a reliable technique to identify ARM nodes in real-time when ALND is performed. The clinical data compared with ARM node histological diagnosis showed only the amount of mitosis in the diagnostic biopsy is a potential predictive factor of ARM node involvement.Clinical trial registrationNCT02994225.