吲哚氰绿荧光示踪技术在肝癌解剖性肝切除中的应用

doi:10.3877/cma.j.issn.2095-3232.2019.03.010

目的

探讨吲哚氰绿（ICG）荧光示踪技术在肝细胞癌（肝癌）解剖性肝切除中的应用价值。

方法

本前瞻性研究对象为2017年6月至2018年7月在中国科学技术大学附属第一医院行解剖性肝切除的55例肝癌患者。患者均签署知情同意书，符合医学伦理学规定。按照随机数字表法随机分为ICG示踪组（28例）和对照组（27例）。其中ICG示踪组男23例，女5例；平均年龄（54±12）岁；应用ICG荧光染色示踪技术行解剖性肝切除。对照组男22例，女5例；年龄（58±12）岁；行常规解剖性肝切除。两组手术相关指标比较采用t检验或χ²检验。

结果

ICG示踪组手术时间为（245±62）min，明显长于对照组的（198±60）min（t=2.857，P<0.05）。ICG示踪组术中输血率7%（2/28），明显低于对照组的45%（12/22）（χ²=10.079，P<0.05）。ICG示踪组术后引流拔管时间、最高体温分别为（6.3±2.4） d、（37.7±0.4）℃，明显少于对照组的（8.4±4.4） d、（38.0±0.6）℃（t=-2.194，-2.179；P<0.05）。

结论

ICG荧光示踪技术可清楚界定肝切除范围，加速患者术后康复，可作为解剖性肝切除的一种辅助手段。

关键词: 癌，肝细胞, 吲哚氰绿, 荧光, 肝切除术

Objective

To investigate the application value of indocyanine green (ICG) fluorescence imaging in anatomical hepatectomy for hepatocellular carcinoma (HCC).

Methods

55 patients with HCC who underwent anatomical hepatectomy in the First Affiliated Hospital of University of Science and Technology of China from June 2017 to July 2018 were enrolled in this prospective study. The informed consents of all patients were obtained and the local ethical committee approval was received. According to the random number table method, all patients were randomly divided into ICG group (n=28) and control group (n=27). In ICG group, 23 patients were male and 5 female, aged (54±12) years on average. Anatomical hepatectomy was performed using ICG fluorescence imaging. In control group, 22 patients were male and 5 female, aged (58±12) years on average. Conventional anatomical hepatectomy was performed. The surgery-related parameters were statistically compared between two groups by using t test or Chi-square test.

Results

In ICG group, the operation time was (245±62) min, significantly longer than (198±60) min in control group (t=2.857, P<0.05). In ICG group, the percentage of intraoperative blood transfusion was 7% (2/28), significantly lower than 45% (12/22) in control group (χ²=10.079, P<0.05). In ICG group, the drainage extubation time was (6.3±2.4) d and the highest body temperature was (37.7±0.4)℃ respectively, significantly less than (8.4±4.4) d and (38.0±0.6)℃ in control group (t=-2.194, -2.179; P<0.05).

Conclusions

ICG fluorescence imaging can clearly define the range of liver resection and accelerate the postoperative rehabilitation of patients, which can serve as an auxiliary approach for anatomical hepatectomy.

Key words: Carcinoma, hepatocellular, Indocyanine green, Fluorescence, Hepatectomy

图1 一例ICG荧光引导下肝癌解剖性肝切除术

表1 ICG示踪组和对照组肝癌肝切除患者术前一般资料比较

临床参数	ICG示踪组	对照组	统计值	P值
男/女	23/5	22/5	χ² =0.000	>0.05
年龄（岁，±s ）	54±12	58±12	t=-1.361	>0.05
肿瘤直径（cm，±s ）	6±3	8±4	t=-1.988	>0.05
HBsAg阳性（例）	21	22	χ² =0.339	>0.05
HBV-DNA定量> 1 000 copies/ml（例）	13	12	χ² =0.022	>0.05
肝硬化（例）	20	21	χ² =0.292	>0.05
AFP阳性（例）	23	25	χ² =0.574	>0.05
肝切除史（例）	2	1	χ² =0.000	>0.05

表1 ICG示踪组和对照组肝癌肝切除患者术前一般资料比较

临床参数	ICG示踪组	对照组	统计值	P值
男/女	23/5	22/5	χ² =0.000	>0.05
年龄（岁，±s ）	54±12	58±12	t=-1.361	>0.05
肿瘤直径（cm，±s ）	6±3	8±4	t=-1.988	>0.05
HBsAg阳性（例）	21	22	χ² =0.339	>0.05
HBV-DNA定量> 1 000 copies/ml（例）	13	12	χ² =0.022	>0.05
肝硬化（例）	20	21	χ² =0.292	>0.05
AFP阳性（例）	23	25	χ² =0.574	>0.05
肝切除史（例）	2	1	χ² =0.000	>0.05

表2 ICG示踪组和对照组肝癌肝切除患者围手术期相关指标比较（±s）

组别	例数	手术时间（min）	术后住院时间（d）	引流管拔管时间（d）
ICG示踪组	28	245±62	10±6	6.3±2.4
对照组	27	198±60	12±5	8.4±4.4
t值	?	2.857	-1.357	-2.194
P值	?	0.006	0.180	0.034

表2 ICG示踪组和对照组肝癌肝切除患者围手术期相关指标比较（±s）

组别	例数	手术时间（min）	术后住院时间（d）	引流管拔管时间（d）
ICG示踪组	28	245±62	10±6	6.3±2.4
对照组	27	198±60	12±5	8.4±4.4
t值	?	2.857	-1.357	-2.194
P值	?	0.006	0.180	0.034

表3 ICG示踪组和对照组肝癌肝切除患者术后并发症发生情况比较（例）

组别	例数	出血	胆漏	腹腔积液	胸腔积液	并发症Clavien分级≥Ⅱ级
ICG示踪组	28	0	0	12	8	8
对照组	27	4	1	14	13	10
χ²值	?	-	-	0.446	2.232	0.447
P值	?	0.111	0.491	0.504	0.135	0.504

表3 ICG示踪组和对照组肝癌肝切除患者术后并发症发生情况比较（例）

组别	例数	出血	胆漏	腹腔积液	胸腔积液	并发症Clavien分级≥Ⅱ级
ICG示踪组	28	0	0	12	8	8
对照组	27	4	1	14	13	10
χ²值	?	-	-	0.446	2.232	0.447
P值	?	0.111	0.491	0.504	0.135	0.504

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Application of indocyanine green fluorescence imaging in anatomical hepatectomy for hepatocellular carcinoma

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Application of indocyanine green fluorescence imaging in anatomical hepatectomy for hepatocellular carcinoma