探讨ICG"四区三相"荧光显像法在机器人解剖性肝切除术中的应用价值。

回顾性分析2019年1月至2019年6月解放军总医院第一医学中心采用ICG"四区三相"荧光显像法行机器人解剖性肝切除术的36例患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男30例，女6例；平均年龄（52±9）岁。采用达芬奇机器人手术系统，通过ICG荧光显像技术结合术中超声探查肿瘤的位置及大小。超声刀和Ligasure等能量器械自下而上、自前向后分层离断肝实质。

所有患者均顺利完成机器人解剖性肝切除。手术时间中位数130（30～250）min，术中出血量120（30～350）ml。术中通过ICG荧光显像联合超声发现隐匿的可疑肿瘤病灶7个，经术中病理检查显示肝细胞癌3个，肝硬化结节3个，肝组织炎性改变1个。术前影像学诊断肿瘤经术后病理检查显示，肝细胞癌34个，胆管细胞癌2个，均为R0切除。ICG荧光显像将肝脏分为4个解剖区域——"肿瘤区"、"瘤周区"、"缺血区"及"预留肝脏区"，机器人腔镜手术系统可将ICG荧光显像中正常相、荧光相、融合相同时显示在主屏幕。

ICG"四区三相"荧光显像法作为一种术中实时导航方法，能精确定位大部分肿瘤，实时清晰显示断肝平面，实现解剖性肝切除的精准化和规范化。

To evaluate the application of ICG "four-zone three-phase" fluorescence imaging in robot-assisted anatomical hepatectomy.

Clinical data of 36 patients who underwent robot-assisted anatomical hepatectomy using ICG "four-zone three-phase" fluorescence imaging from January to June 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 30 patients were male and 6 female, aged (52±9) years on average. Using da Vinci robot-assisted surgery system, the tumor location and size were detected by ICG fluorescence imaging technology combined with intraoperative ultrasound. The liver parenchyma was separated and resected layer-by-layer from bottom to top and front to back by using CUSA, Ligasure and other energy instruments.

All the patients completed robot-assisted anatomical hepatectomy successfully. The median operation time was 130 (30-250) min and intraoperative blood loss was 120(30-350) ml. Intraoperative ICG fluorescence imaging combined with ultrasound found 7 suspicious invisible tumor lesions, of which 3 lesions were diagnosed as hepatocellular carcinoma by intraoperative pathological examination, 3 cirrhosis nodules and 1 inflammatory change. 34 lesions were diagnosed as hepatocellular carcinoma and 2 cholangiocarcinoma by preoperative imaging diagnosis combined with postoperative pathological examination, and all underwent R0 resection. According to ICG fluorescence imaging, the liver was divided into 4 anatomical zones including "tumor zone", "peritumor zone", "ischemia zone" and "reserved liver zone". The normal phase, fluorescence phase and fusion phase of ICG fluorescence imaging could be simultaneously displayed on the main screen by the robot-assisted endoscopic surgery system.

As a real-time intraoperative navigation method, ICG "four-zone three-phase" fluorescence imaging can accurately locate most tumors, clearly display the liver resection plane in a real-time manner and achieve the precision and standardization of anatomical hepatectomy.