吲哚菁绿荧光显像技术在腹腔镜肝切除治疗原发性肝癌中的应用

  目的  研究吲哚菁绿(indocyanine green，ICG)分子荧光显像技术在腹腔镜肝切除治疗原发性肝癌中的应用价值。  方法  回顾性分析2018年12月—2020年9月蚌埠医学院第一附属医院肝胆外科行ICG荧光腹腔镜肝切除术的56例原发性肝癌患者的临床及病理资料，统计分析手术方式、术前染色方法、术中荧光下肿瘤显影特点、新病灶的检测、手术后肿瘤病理结果等。  结果  所有患者均在ICG荧光腹腔镜下顺利完成肝切除手术，无中转开腹。有9例患者在荧光显像下出现新的可疑病灶，术中快速冰冻切片病理检查提示有4例证实为肝细胞性肝癌，1例为炎性改变，4例为硬化结节，9例患者中合并肝硬化患者8例。术中因肝硬化严重或交通支的存在导致10例患者染色失败，仅术前注射ICG的患者有8例染色失败，术中加行反染法的患者有2例染色失败。Child-Pugh分级为A级的患者在术前2 d或3 d给药可以在术中得到良好的显影效果，而B级的患者在术前5 d给药后荧光下肿瘤显影最佳。所有患者术后均无严重并发症发生，恢复良好。  结论  ICG荧光显像技术的发展为外科医生提供了一种简单有效的导航办法，可以准确定位肿瘤位置及切除边界，帮助发现浅表的微小病灶，但是具体如何界定肝硬化程度与注射时间仍需要讨论。 

Application of ICG fluorescence imaging in laparoscopic hepatectomy for primary liver cancer

  Objective  To study the application value of indocyanine green (ICG) molecular fluorescence imaging in laparoscopic hepatectomy for primary liver cancer.  Methods  The clinical and pathological data of 56 patients with primary liver cancer who underwent ICG fluorescence laparoscopic hepatectomy in the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Bengbu Medical College from December 2018 to September 2020 were analysed retrospectively. The operative methods, the methods of preoperative staining, the characteristics of intraoperative fluorescence tumour development, the detection of new lesions and the pathological results of tumour after operation were statistically analysed.  Results  All patients successfully completed hepatectomy under ICG fluorescence laparoscopy without conversion to laparotomy. New suspicious lesions were found in 9 patients under fluorescence imaging. Pathological examination of intraoperative rapid frozen section showed 4 cases of hepatocellular carcinoma, 1 case of inflammatory changes and 4 cases of sclerotic nodules. Amongst the 9 patients, eight cases were complicated with liver cirrhosis. During the operation, staining failed in 10 patients due to severe liver cirrhosis or the presence of communicating branches. Staining failed in 8 patients who were injected with ICG before operation and 2 patients who received anti-staining during operation. The patients of Child-Pugh grade A could obtain a good development effect 2 or 3 days before operation, whereas those of grade B had the best tumour development under fluorescence 5 days before operation. All patients had no serious complications and recovered well.  Conclusion  The development of ICG fluorescence imaging technology provides surgeons with a simple and effective navigation method that can accurately locate the tumour and resection boundary and help to find superficial small lesions. However, how to define the degree of liver cirrhosis and injection time still need to be discussed.