探讨基于"红/黄交界线"胆囊板入路联合ICG荧光导航技术在腹腔镜解剖性肝切除术中应用的安全性和疗效。

本研究对象为2021年1月至2023年1月在中国科学技术大学附属第一医院收治的10例腹腔镜解剖性肝切除患者。患者均签署知情同意书，符合医学伦理学规定。其中男9例，女1例；年龄44～77岁，中位年龄59岁。患者麻醉医师协会（ASA）分级为Ⅰ级9例，Ⅱ级1例；术前肝功能Child-Pugh分级均为A级，术前ICGR15≤0.10；术前增强CT或MRI诊断为肝肿瘤。术中采用基于"红/黄交界线"的胆囊板入路分离阻断目标肝蒂，然后ICG荧光反染显示肝区/段边界，超声刀逐步切除目标肝脏。观察患者术中、术后指标及并发症等。

10例患者均经基于"红/黄交界线"的胆囊板入路成功分离并阻断目标肝蒂，反染成功后正确显示目标肝脏范围，顺利完成腹腔镜解剖性肝切除术。无中转开腹，无发生围手术期死亡。手术方式：肝右叶切除7例，其中Ⅴ段切除3例，Ⅵ段切除2例，Ⅷ段切除1例，Ⅴ、Ⅵ段联合切除1例；肝左叶切除3例，其中左半肝切除1例，Ⅳ段切除2例。术中出血量中位数500（20～800）ml，肝门阻断时间30（19～60）min，手术时间300（112～405）min。术后住院时间8.5（5.0～15.0）d，术后ALT峰值245（110～702）U/L，术后AST峰值281（88～561）U/L。所有患者无Clavien-Dindo Ⅲa级以上并发症及死亡。术后病理示肝细胞癌8例，肝胆管细胞癌1例，直肠癌肝转移1例。随访时间13～21个月，中位随访时间15个月，随访期间10例患者均存活，1例患者术后18个月后复发。

基于"红/黄交界线"的胆囊板入路联合ICG荧光导航技术在提高了腹腔镜解剖性肝切除术患者安全、便捷性的同时，实现了精准肝切除。

To evaluate the safety and efficacy of laparoscopic anatomical hepatectomy via cystic plate approach using "peritoneal reflection" combined with ICG fluorescence navigation.

10 patients undergoing laparoscopic anatomical hepatectomy admitted to the First Affiliated Hospital of University of Science and Technology of China from January 2021 to January 2023 were enrolled in this study. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 9 patients were male and 1 female, aged from 44 to 77 years, with a median age of 59 years. According to the American Society of Anesthesiologists (ASA) Physical Status Classification System, 9 patients were diagnosed with Class Ⅰ and 1 case of Class Ⅱ. Preoperative liver function was evaluated as Child-Pugh A and preoperative ICGR15≤0.10 in all patients. Preoperative enhanced CT scan or MRI prompted the diagnosis of liver tumor. Intraoperatively, the target liver pedicle was separated and blocked via cystic plate approach based on "peritoneal reflection". ICG fluorescence reverse staining showed the liver region/segment boundary. The target liver was gradually resected by ultrasonic knife. Intraoperative and postoperative indexes and complications were observed.

The target liver pedicle was successfully separated and blocked via cystic plate approach based on "peritoneal reflection" in 10 patients. The target liver was precisely displayed after successful reverse staining, and laparoscopic anatomical hepatectomy was successfully performed. No conversion to open surgery or perioperative death occurred. Regarding surgical patterns, 7 patients underwent resection of the right lobe, including segment Ⅴ resection in 3 cases, segment Ⅵ resection in 2 cases, segment Ⅷ resection in 1 case, and combined resection of segment Ⅴ and segment Ⅵ in 1 case. 3 patients received resection of the left lobe, including the left lobe resection in 1 case and segment Ⅳ resection in 2 cases. The median intraoperative blood loss was 500(20-800) ml. The portal occlusion time was 30(19-60) min. The operation time was 300(112-405) min. The length of postoperative hospital stay was 8.5(5.0-15.0) d. Postoperative peak ALT level was 245(110-702) U/L, and postoperative peak AST level was 281(88-561) U/L. No Clavien-Dindo grade Ⅲa or above complications or death of the patients were observed. Postoperative pathological examination confirmed hepatocellular carcinoma in 8 cases, cholangiocellular carcinoma in 1 case and hepatic metastasis of rectal cancer in 1 case. The median follow-up time was 15 months (13 to 21 months). All 10 patients survived during postoperative follow-up, and 1 patient recurred at 18 months after surgery.

Cystic plate approach using "peritoneal reflection" combined with ICG fluorescence navigation can improve the safety and convenience for patients undergoing laparoscopic anatomical hepatectomy and achieve precise hepatectomy.