探讨ICG荧光引导腹腔镜射频消融在合并严重大结节肝硬化小肝癌患者治疗中的应用价值。

回顾性分析2021年12月至2022年6月在第九〇〇医院应用ICG荧光引导腹腔镜射频消融治疗的14例合并严重大结节肝硬化小肝癌患者临床资料。其中男13例，女1例；年龄45～82岁，中位年龄65岁。患者均签署知情同意书，符合医学伦理学规定。肿瘤均位于近肝被膜下，病灶直径0.8～3.0 cm。患者术前注射ICG，行术中荧光腹腔镜探查、肿瘤定位后再行射频消融，观察消融效果及术后恢复情况。

14例均为术中肉眼难以鉴别的肿瘤与硬化结节，其中13例在多模荧光和标准荧光下能清晰鉴别肿瘤位置、边界，并顺利完成射频消融。1例术中见全肝荧光染色，无法鉴别，联合术中超声定位肿瘤后完成射频消融。14例患者术后恢复顺利，均无并发症发生，中位住院时间13 d。术后1个月复查MRI，均达到肿瘤完全消融。

对于肝被膜下合并严重大结节肝硬化小肝癌患者，ICG荧光引导腹腔镜射频消融具有可靠的定位和定性诊断价值方法，是可行、有效的治疗手段。

To evaluate the application value of ICG fluorescence-guided laparoscopic radiofrequency ablation in the treatment of small liver cancer complicated with severe macronodular cirrhosis.

Clinical data of 14 small liver cancer patients complicated with severe macronodular cirrhosis treated with ICG fluorescence-guided laparoscopic radiofrequency ablation in the 900^th Hospital from December 2021 to June 2022 were retrospectively analyzed. Among them, 13 patients were male and 1 female, aged from 45 to 82 years, with a median age of 65 years. The informed consents of all patients were obtained and the local ethical committee approval was received. All tumors were located adjacent to the liver capsule, and the lesion size was ranged from 0.8 to 3.0 cm in diameter. All patients were injected with ICG before surgery, received intraoperative fluorescence-guided laparoscopic exploration and tumor localization, and then underwent radiofrequency ablation. The ablation effect and postoperative recovery were observed.

All 14 patients were diagnosed with indistinguishable tumors and cirrhotic nodules intraoperatively. Among them, tumor location and margin could be clearly identified under multimode and standard fluorescence in 13 cases, and they successfully completed radiofrequency ablation. Intraoperatively, fluorescence staining of the whole liver was found in 1 case, which could not be identified. Radiofrequency ablation was performed after intraoperative ultrasound localization of the tumor. 14 patients were properly recovered without complications. The median length of hospital stay was 13 d. MRI at 1 month after surgery showed that complete tumor ablation was achieved in all cases.

ICG fluorescence-guided laparoscopic radiofrequency ablation is a feasible and efficacy for small liver cancer patients complicated with severe macronodular cirrhosis, which yields reliable localization and qualitative diagnostic value.