A-P-R三角解剖联合ICG荧光染色腹腔镜解剖性肝S5段切除术

doi:10.3877/cma.j.issn.2095-3232.2022.05.014

中华肝脏外科手术学电子杂志 ›› 2022, Vol. 11 ›› Issue (05) : 498 -502. doi: 10.3877/cma.j.issn.2095-3232.2022.05.014

临床研究

A-P-R三角解剖联合ICG荧光染色腹腔镜解剖性肝S5段切除术

王鹏¹, 荣维淇², 张建¹, 潘国政¹, 吴凡², 王黎明², 吴健雄², 王宏光²^,^†(

)

^1. 257099　山东省东营市，山东省胜利油田中心医院肝胆外科
^2. 100021　中国医学科学院北京协和医学院附属肿瘤医院肝胆外科　国家癌症中心　国家肿瘤临床医学研究中心

收稿日期:2022-05-05 出版日期:2022-10-10
通信作者: 王宏光
基金资助:
北京市自然科学基金(4222058); 希思科-默沙东肿瘤研究基金(Y-MSDPU2021-0082)

Application of A-P-R triangle dissection combined with ICG fluorescence staining in laparoscopic anatomical S5 segmentectomy

Peng Wang¹, Weiqi Rong², Jian Zhang¹, Guozheng Pan¹, Fan Wu², Liming Wang², Jianxiong Wu², Hongguang Wang²^,^†()

^1. Department of Hepatobiliary Surgery, Shengli Oilfield Central Hospital, Dongying 257099, China
^2. Department of Hepatobiliary Surgery, Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Cancer Center, National Clinical Research Center for Cancer, Beijing 100021, China

Received:2022-05-05 Published:2022-10-10
Corresponding author: Hongguang Wang

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引用本文：

王鹏, 荣维淇, 张建, 潘国政, 吴凡, 王黎明, 吴健雄, 王宏光. A-P-R三角解剖联合ICG荧光染色腹腔镜解剖性肝S5段切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2022, 11(05): 498-502.

Peng Wang, Weiqi Rong, Jian Zhang, Guozheng Pan, Fan Wu, Liming Wang, Jianxiong Wu, Hongguang Wang. Application of A-P-R triangle dissection combined with ICG fluorescence staining in laparoscopic anatomical S5 segmentectomy[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2022, 11(05): 498-502.

目的

探讨A-P-R三角解剖联合ICG荧光染色腹腔镜解剖性肝S5段切除术的安全性和可行性。

方法

回顾性分析2020年12月1日至2021年5月30日在中国医学科学院北京协和医学院附属肿瘤医院和胜利油田中心医院行腹腔镜肝S5段切除术的7例原发性肝癌患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男5例，女2例；年龄54~72岁，中位年龄65岁。术中解剖A-P-R三角联合ICG荧光染色显示肝段分界，实施腹腔镜下解剖性肝S5段切除术。观察患者术中及术后情况。

结果

所有患者均顺利完成手术，无中转开腹。其中单纯S5段切除3例，联合S4b段部分切除1例，联合S6段部分切除3例。手术时间中位数211（162~265）min，肝门阻断时间32（15~75）min，术中出血量150（50~300）ml，均无输血。术后住院时间7（3~14）d。术后无发生腹腔出血、肝衰竭等严重并发症。术后胆漏1例，保持通畅引流，术后20 d拔管。所有病例随访至投稿日，无肿瘤复发转移，无死亡。

结论

采用A-P-R三角解剖联合ICG荧光染色辅助腹腔镜解剖性肝S5段切除术安全、可行。

关键词: A-P-R三角, 吲哚氰绿, 荧光显像, 腹腔镜, 肝切除术, 癌，肝细胞

Objective

To evaluate the safety and feasibility of A-P-R triangle dissection combined with ICG fluorescence staining in laparoscopic anatomical S5 segmentectomy.

Methods

Clinical data of 7 patients with primary liver cancer undergoing laparoscopic anatomical S5 segmentectomy in Cancer Hospital of Peking Union Medical College, Chinese Academy of Medical Sciences and Shengli Oilfield Central Hospital from December 1, 2020 to May 30, 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them,5 patients were male and 2 female, aged from 54 to 72 years, with a median age of 65 years. Intraoperatively, A-P-R triangle dissection combined with ICG fluorescence staining were adopted to display the boundary of liver segments, and laparoscopic anatomical S5 segmentectomy was performed. Intraoperative and postoperative conditions of all patients were observed.

Results

All the patients underwent the surgery successfully without conversion to open surgery. Among them, 3 cases underwent S5 segmentectomy alone, 1 case underwent S5 segmentectomy combined with partial S4b segmentectomy and 3 cases ofS5 segmentectomy combined with partial S6 segmentectomy, respectively. The median operation time was 211(162-265) min, the hepatic portal occlusion time was 32(15-75) min, and intraoperative blood loss was 150(50-300) ml. No blood transfusion was delivered. The length of postoperative hospital stay was7(3-14) d. No severe complications, such as abdominal hemorrhage and liver failure, occurred after surgery. Postoperative bile leakage occurred in 1 case, who received drainage and extubation at postoperative 20 d. All patients were followed up till the day of manuscript submission. No tumor recurrence, metastasis or death was reported.

Conclusions

It is safe and feasible to perform A-P-R triangle dissection combined with ICG fluorescence staining in laparoscopic anatomical S5 segmentectomy.

Key words: A-P-R triangle, Indocyanine green, Fluorescence imaging, Laparoscopes, Hepatectomy, Carcinoma, hepatocellular

图1 肝脏A-P-R三角解剖示意图注：RHV为肝右静脉，RP为右肝蒂，AP为右前肝蒂，PP为右后肝蒂，SP为左尾叶支，CP为尾状突支；该图为中山大学孙逸仙纪念医院曹君教授团队绘制

图2 一例A-P-R三角解剖联合ICG荧光染色腹腔镜解剖性肝S5段切除术手术过程注：a为A-P-R三角初解剖，显露AP和PP；b术中超声定位目标肝蒂，确定S5段肝蒂众多门静脉分支；c、d为ICG反染显示S5段与S6、S8段分界线；e为A-P-R三角再解剖,显露RHV；f为肝S5段切除术后肝断面；RP为右肝蒂，AP为右前肝蒂，PP为右后肝蒂，RHV为肝右静脉，V4b、V5d、V5v、V6为引流对应肝段的肝静脉，P5、P6、P7为相应肝段门静脉，T为肿瘤

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