目的

探讨三维可视化结合ICG显像技术在腹腔镜肝切除术治疗复发性肝细胞癌（肝癌）中的应用价值。

方法

回顾性分析2022年1月至2023年6月在宝鸡市人民医院接受手术的5例复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2例，女3例；年龄49～78岁，中位年龄66岁。术前采用计算机辅助手术系统行三维可视化肝脏重建，结合术中ICG荧光显像技术行腹腔镜肝切除术。评估该技术在复发性肝癌中应用的安全性和可行性。

结果

5例患者均顺利完成腹腔镜肝切除术，无中转开腹。平均手术时间（274±18）min，术中出血量（390±85）ml。1例患者术后出现胆漏，充分引流后治愈。术后无发生出血、腹腔感染和肝衰竭。肝切缘均阴性。术后住院时间（9.2±1.9）d。5例患者均获得随访，随访时间6～24个月，随访期间无肿瘤复发。无术后90 d内死亡病例。

结论

对于复发性肝癌腹腔镜肝切除术患者，三维可视化结合ICG荧光显像技术是安全可行的，术中操作可更精准定位肿瘤，具有创伤小、出血少等潜在的优势。

Objective

To evaluate the application value of three-dimensional visualization combined with ICG imaging in laparoscopic hepatectomy for recurrent hepatocellular carcinoma （HCC）.

Methods

Clinical data of 5 patients with recurrent HCC who underwent surgery in Baoji People's Hospital from January 2022 to June 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them，2 patients were male and 3 female，aged 49-78 years，with a median age of 66 years. Preoperatively，three-dimensional visualized liver reconstruction was performed by computer-aided surgical system，and combined with intraoperative ICG fluorescence imaging for laparoscopic hepatectomy. The safety and feasibility of this technology in the treatment of recurrent HCC were evaluated.

Results

All 5 patients successfully completed laparoscopic hepatectomy without conversion to open surgery. The average operation time was （274±18） min，and intraoperative blood loss was （390±85） ml. 1 patient developed postoperative bile leakage and was cured after adequate drainage. No bleeding，abdominal infection or liver failure occurred after operation. Surgical margin of the liver was negative. The length of postoperative hospital stay was （9.2±1.9） d. All 5 patients were followed up for 6-24 months，and there was no tumor recurrence during postoperative follow-up. No patient died within postoperative 90 d.

Conclusions

Three-dimensional visualization combined with ICG fluorescence imaging technology is safe and feasible for patients with recurrent HCC undergoing laparoscopic hepatectomy. Intraoperatively，it can precisely locate the tumor and has potential advantages of mild trauma and slight bleeding.