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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2025, Vol. 14 ›› Issue (06) : 852 -859. doi: 10.3877/cma.j.issn.2095-3232.2025.06.007

临床研究

ICG荧光成像引导下腹腔镜肝切除术治疗肝癌的安全性和有效性Meta分析
吴哲境, 李敬东†()   
  1. 637000　四川省　南充市，川北医学院附属医院肝胆外科　川北医学院肝胆胰肠疾病研究所
  • 收稿日期:2025-06-05 出版日期:2025-12-10
  • 通信作者: 李敬东
  • 基金资助:
    四川省科技计划项目(2024YFHZ0052)

Meta-analysis of safety and efficacy of ICG fluorescence imaging-guided laparoscopic hepatectomy for liver cancer

Zhejing Wu, Jingdong Li†()   

  1. Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Institute of Hepatobiliary Pancreatic Intestinal Diseases of North Sichuan Medical College, Nanchong 637000, China
  • Received:2025-06-05 Published:2025-12-10
  • Corresponding author: Jingdong Li
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引用本文：

吴哲境, 李敬东. ICG荧光成像引导下腹腔镜肝切除术治疗肝癌的安全性和有效性Meta分析[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(06): 852-859.

Zhejing Wu, Jingdong Li. Meta-analysis of safety and efficacy of ICG fluorescence imaging-guided laparoscopic hepatectomy for liver cancer[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(06): 852-859.

目的

系统评价ICG荧光成像引导腹腔镜肝癌切除术（FIGLTR）的安全性与有效性。

方法

系统检索在PubMed、Web of Science、Embase、中国知网数据库、万方数据库和维普数据库中2024年7月21日前发表的相关临床研究。搜索策略包括吲哚菁绿、荧光成像、腹腔镜、肝切除术、肝癌、肝肿瘤、indocyanine green、fluorescence imaging、laparoscopic、liver tumor、hepatectomy等关键词。评估纳入研究质量后提取临床数据。采用Review Manager 5.4软件对总体结果进行Meta分析，采用固定效应或随机效应模型来计算综合效应大小。漏斗图进行偏倚分析，使用Begg检验和（或）Egger检验评估漏斗图的不对称性。

结果

本Meta分析包括28项回顾性队列研究，4篇RCT研究，2 630例患者，其中非FIGLTR组1 386例，FIGLTR组1 244例。Meta分析显示，非FIGLTR组手术时间（MD=12.60，95%CI：2.99~22.21）、术中出血量（MD=52.19，95%CI：32.41~71.96）、输血率（OR=1.90，95%CI：1.17~3.09）、R0切除率（OR=0.38，95%CI：0.24~0.62）、术后总体并发症发生率（OR=1.61，95%CI：1.30~2.00）、术后住院时间（MD=0.86，95%CI：0.21~1.52） 较FIGLTR组均明显增加（P<0.05）。而两组在肝门阻断时间（MD=-0.92，95%CI：-4.64~2.80）、最小切缘宽度（MD=-3.12，95%CI：-9.61~3.37）和总住院时间（MD=-0.18，95%CI：-2.85~2.50）比较，差异无统计学意义（P>0.05）。敏感性分析和漏斗图分析证实Meta分析结果稳定可靠。

结论

Meta分析研究表明FIGLTR提高了肝癌患者R0切除率的同时不会影响手术最小切缘宽度，且手术安全性更高、恢复更快、并发症发生率更低。

关键词: 吲哚菁绿, 荧光成像, 腹腔镜, 肝切除术, 癌，肝细胞, 肝肿瘤, Meta分析
Objective

To systematically evaluate the safety and efficacy of indocyanine green (ICG) fluorescence imaging-guided laparoscopic hepatectomy (FIGLTR).

Methods

Relevant clinical studies published before July 21, 2024 were systematically searched from PubMed, Web of Science, Embase, CNKI, Wanfang Data and Chongqing VIP databases. The searching keywords included indocyanine green, fluorescence imaging, laparoscopic, hepatectomy, liver cancer and liver tumor. Clinical data were extracted after evaluating the quality of included studies. The overall results were subject to meta-analysis using Review Manager 5.4 software. The comprehensive effect was evaluated by fixed effect or random effect models. The publication bias was assessed by funnel chart. The asymmetry of funnel chart was assessed by Begg test and/or Egger test.

Results

In this meta-analysis, 28 retrospective cohort studies and 4 RCTs were included, comprising 2 630 patients including 1 386 in the non-FIGLTR group and 1 244 in the FIGLTR group. Meta-analysis showed that operation time (MD=12.60, 95%CI: 2.99-22.21), intraoperative blood loss (MD=52.19, 95%CI: 32.41-71.96), blood transfusion rate (OR=1.90, 95%CI: 1.17-3.09), R0 resection rate (OR=0.38, 95%CI: 0.24-0.62), overall incidence of postoperative complications (OR=1.61, 95%CI: 1.30-2.00) and the length of postoperative hospital stay (MD=0.86, 95%CI: 0.21-1.52) in the non-FLIGLTR group were significantly increased than those in the FIGLTR group (all P<0.05). However, no statistical significance was observed in the hepatic portal occlusion time (MD=-0.92, 95%CI: -4.64-2.80), the minimum resection margin width (MD=-3.12, 95%CI: -9.61-3.37) and the total length of hospital stay (MD=-0.18, 95%CI: -2.85-2.50) (all P>0.05). Sensitivity analysis and funnel chart analysis confirmed that the results of meta-analysis were stable and reliable.

Conclusions

Meta-analysis demonstrates that FIGLTR can improve the R0 resection rate of patients with liver cancer without affecting the minimum resection margin width. It yields higher safety, faster recovery and lower incidence of complications compared with non-FIGLTR.

Key words: Indocyanine green(ICG), Fluorescence imaging, Laparoscopy, Hepatectomy, Carcinoma, hepatocellular, Liver tumour, Meta-analysis
表1 FIGLTR治疗肝癌的安全性和有效性Meta分析纳入文献基本特征及质量评分
第一作者 发表年份 国家 研究类型 样本量（C/I） NOS/Jadad评分（分）
Handgraaf HM [12] 2017 荷兰 RCS 87/67 8
Aoki T[13] 2018 日本 RCS 72/25 6
Zhou Y[14] 2019 中国 RCS 21/21 6
Zhang P[15] 2019 中国 RCS 34/30 6
Lu H[16] 2020 中国 RCS 63/57 7
Chen H[17] 2022 中国 RCS 60/48 6
Hanaki T[18] 2022 日本 RCS 26/23 6
He K[19] 2022 中国 RCT 32/32 5
Itoh S[20] 2022 日本 RCS 32/32 6
Jianxi W[21] 2022 中国 RCS 81/81 8
Wang G[22] 2022 中国 RCS 11/14 7
Liu F[23] 2022 中国 RCS 50/50 8
Zhou Y[24] 2023 中国 RCS 36/36 8
Zhu W[25] 2023 中国 RCS 34/42 7
Wang D[26] 2024 中国 RCS 53/45 8
雷光林[27] 2019 中国 RCS 54/36 7
马家豪[28] 2019 中国 RCS 40/35 6
肖二卫[29] 2019 中国 RCS 46/67 6
姚舜禹[30] 2019 中国 RCT 27/28 4
潘玉进[31] 2020 中国 RCS 43/42 7
邹雄峰[32] 2020 中国 RCS 65/65 8
杜波[33] 2021 中国 RCT 48/48 2
王锦祥[34] 2021 中国 RCS 40/40 7
辛富理[35] 2021 中国 RCS 31/31 7
姚韩[36] 2021 中国 RCS 42/22 6
陈晓宁[37] 2022 中国 RCS 21/20 7
胡宇[38] 2022 中国 RCS 69/52 8
刘克文[39] 2023 中国 RCS 40/40 7
刘向东[40] 2023 中国 RCS 24/28 6
孙海峰[41] 2023 中国 RCT 39/31 3
唐啸[42] 2023 中国 RCS 39/31 8
周毅[43] 2023 中国 RCS 26/25 7
图1 非FIGLTR组与FIGLTR组手术时间的Meta分析森林图 注：FIGLTR为吲哚菁绿荧光成像引导腹腔镜肝癌切除术
图2 FIGLTR治疗肝癌的安全性和有效性Meta分析的漏斗图 注：a为手术时间；b为术中出血量；c为输血率；术中出血量漏斗图出现明显向右侧偏移，其余大致呈对称分布；FIGLTR为吲哚菁绿荧光成像引导腹腔镜肝癌切除术
图3 FIGLTR治疗肝癌术中出血量Meta分析的剪补法分析 注：FIGLTR为吲哚菁绿荧光成像引导腹腔镜肝癌切除术
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