探讨ICG荧光影像技术在腹腔镜精准肝段切除术中的应用价值。

回顾性分析2020年5月至2022年2月在中国科学技术大学附属第一医院行ICG荧光引导腹腔镜精准肝段切除术的16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13例，女3例；年龄35~67岁，中位年龄57岁。肝细胞癌15例，肝脏局灶性结节增生1例。术前肝功能均为Child-Pugh分级A级。根据肿瘤位置情况采用不同ICG染色方法，包括ICG肿瘤染色、正向染色法和反向染色法。观察患者术中ICG染色情况和围手术期情况。

15例成功实施ICG荧光引导腹腔镜精准肝段切除术，仅1例染色失败，无中转开腹。其中S1段肝尾状叶切除2例，采用ICG肿瘤染色法；S2段1例，S3段2例，采用正向染色法；S4段2例，S5段1例，采用反向染色法；S6段4例，S7段1例，S8段3例，采用正向染色法。手术时间中位数245（226~278）min，肝门阻断时间30（20~30）min，术中出血量200（100~300）ml，术中输血2例，术后住院时间6（5~8）d。无发生术后90 d内死亡或Clavien-DindoⅡ级以上并发症。

ICG荧光可全程、实时、高效引导腹腔镜肝段切除术，具有精准、微创、安全的优势。

To evaluate the application value of ICG fluorescence imaging in precise laparoscopic hepatectomy.

Clinical data of 16 patients who underwent ICG fluorescence-guided precise laparoscopic hepatectomy in the First Affiliated Hospital of China University of Science and Technology from May 2020 to February 2022 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 13 patients were male and 3 female, aged from 35 to 67 years, with a median age of 57 years. 15 patients were diagnosed with hepatocellular carcinoma and 1 case with focal nodular hyperplasia of the liver. All patients were classified as Child-Pugh grade A before surgery. According to the tumor location, different ICG staining methods were adopted including ICG tumor staining, positive staining and negative staining. Intraoperative ICG staining and perioperative conditions were observed.

15 patients underwent ICG fluorescence-guided precise laparoscopic hepatectomy successfully, while the staining of 1 case failed. No conversion to open surgery was conducted. Among them, resection of caudate lobe segment 1 were performed in 2 cases and ICG tumor staining was employed. Resection of segment 2 was performed in 1 case, and segment 3 in 2 cases, and positive staining was adopted. Segment 4 resection was conducted in 2 and segment 5 in 1 case, and negative staining was carried out. Segment 6 resection was performed in 4 cases, segment 7 in 1 case and segment 8 in 3 cases, and positive staining was adopted. The median operation time was 245(226-278) min, the hepatic portal occlusion time was 30(20-30) min, intraoperative blood loss was 200(100-300) ml, intraoperative blood transfusion was performed in 2 cases, and the length of postoperative hospital stay was 6(5-8) d. No death case was observed within postoperative 90 d. No Clavien-Dindo gradeⅡ or above complications were reported.

ICG fluorescence can deliver real-time and highly-efficient guidance for the entire process of laparoscopic hepatectomy, which possesses the advantages of precision, minimal invasiveness and safety.