Application of three-dimensional visualization technology, ICG fluorescence tracing and intraoperative real-time ultrasound in individualized precise diagnosis and treatment of liver cancer

doi:10.3877/cma.j.issn.2095-3232.2026.02.007

Abstract

Abstract:

In recent years, three-dimensional visualization technology (3DVT), ICG fluorescence tracing and intraoperative real-time ultrasound (IORUS) have been widely applied in the diagnosis and treatment of liver cancer, which significantly improve the accuracy of early diagnosis, localization, surgical resection and postoperative monitoring of liver cancer. 3DVT provides surgeons with intuitive preoperative evaluation and intraoperative navigation by integrating anatomical liver structures and tumor information, which effectively reduces the risk of surgery. As a safe and efficient fluorescent dye, ICG can mark the blood supply status of tumors in a real-time manner, assist the surgeons to clearly identify the tumor margins and improve the success rate of tumor resection. Due to high-resolution imaging capability, IORUS can realize real-time monitoring of liver lesions, ensuring the accuracy and safety of the operation. The application of 3DVT, ICG fluorescence tracing and IORUS provides novel ideas for individualized diagnosis and treatment of liver cancer and promotes the development of precise treatment of liver cancer. In this article, the application of 3DVT, ICG and IORUS in the diagnosis and treatment of liver cancer was illustrated, aiming to provide novel insights for clinical diagnosis and treatment of liver cancer.

Key words: Carcinoma,hepatocellular, Three-dimensional visualization technology, Indocyanine green fluorescence tracing, Intraoperative real-time ultrasound(IORUS)

Xiaoge Dong, Haining Fan, Lichao Hou, Kaihao Du, Haigang Liu, Zhanjin Wang, Weiwei Xue, Yachao Shi, Liumu Wei, Zhan Wang. Application of three-dimensional visualization technology, ICG fluorescence tracing and intraoperative real-time ultrasound in individualized precise diagnosis and treatment of liver cancer[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2026, 15(02): 181-189.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3232.2026.02.007

https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/Y2026/V15/I02/181

References 57

[1]	中华人民共和国国家卫生健康委员会医政司. 原发性肝癌诊疗指南(2024年版)[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(4): 407-449.DOI: 10.3877/cma.j.issn.2095-3232.2024.04.001.
[2]	郑荣寿, 陈茹, 韩冰峰, 等. 2022年中国恶性肿瘤流行情况分析[J]. 中华肿瘤杂志, 2024, 46(3): 221-231.DOI: 10.3760/cma.j.cn112152-20240119-00035.
[3]	Zheng R, Zhang S, Zeng H, et al. Cancer incidence and mortality in China, 2016[J]. J Natl Cancer Cent, 2022, 2(1): 1-9.DOI: 10.1016/j.jncc.2022.02.002.
[4]	中华医学会数字医学分会, 中国医师协会肝癌专业委员会, 中国医师协会临床精准医学专业委员会, 等. 复杂性肝脏肿瘤三维可视化精准诊治指南(2019版)[J]. 中国实用外科杂志, 2019, 39(8): 766-774.DOI: 10.19538/j.cjps.issn1005-2208.2019.08.02.
[5]	Fang C, An J, Bruno A, et al. Consensus recommendations of three-dimensional visualization for diagnosis and management of liver diseases[J]. Hepatol Int, 2020, 14(4): 437-453.DOI: 10.1007/s12072-020-10052-y.
[6]	李开富, 唐永成, 唐浩, 等. 三维可视化技术辅助肝细胞癌消融治疗有效性及安全性的Meta分析[J]. 临床肝胆病杂志, 2024, 40(7): 1397-1403.DOI: 10.12449/JCH240718.
[7]	张雷鸣, 张庆桥, 沙俊诚, 等. 三维可视化技术在原发性肝癌经动脉化疗栓塞术中的应用[J]. 山东医药, 2023, 63(26): 72-74.DOI: 10.3969/j.issn.1002-266X.2023.26.018.
[8]	Tan Y, Zhu JY, Li J, et al. Application of 3-dimensional visualization and image fusion technology in liver cancer with portal vein tumor thrombus surgery[J]. Medicine, 2024, 103(30): e38980.DOI: 10.1097/MD.0000000000038980.
[9]	Fang CH, Zhang P, Zhou WP, et al. Efficacy of three-dimensional visualization technology in the precision diagnosis and treatment for primary liver cancer: a retrospective multicenter study of 1 665 cases in China[J]. Zhonghua Wai Ke Za Zhi, 2020, 58(5): 375-382.DOI: 10.3760/cma.j.cn112139-20200220-00105.
[10]	Okuda Y, Taura K, Seo S, et al. Usefulness of operative planning based on 3-dimensional CT cholangiography for biliary malignancies[J]. Surgery, 2015, 158(5): 1261-1271.DOI: 10.1016/j.surg.2015.04.021.
[11]	张势域, 成剑文, 闫加艳, 等. 三维可视化技术在中晚期肝细胞癌外科治疗中的应用价值[J]. 中国普通外科杂志, 2023, 32(7): 977-985.DOI: 10.7659/j.issn.1005-6947.2023.07.002.
[12]	Zeng X, Tao H, Dong Y, et al. Impact of three-dimensional reconstruction visualization technology on short-term and long-term outcomes after hepatectomy in patients with hepatocellular carcinoma: a propensity-score-matched and inverse probability of treatment-weighted multicenter study[J]. Int J Surg, 2024, 110(3): 1663-1676.DOI: 10.1097/JS9.0000000000001047.
[13]	Giehl-Brown E, Dennler S, Garcia SA, et al. 3D liver model-based surgical education improves preoperative decision-making and patient satisfaction-a randomized pilot trial[J]. Surg Endosc, 2023, 37(6): 4545-4554.DOI: 10.1007/s00464-023-09915-w.
[14]	Landsman ML, Kwant G, Mook GA, et al. Light-absorbing properties, stability, and spectral stabilization of indocyanine green[J]. J Appl Physiol, 1976, 40(4): 575-583.DOI: 10.1152/jappl.1976.40.4.575.
[15]	Alander JT, Kaartinen I, Laakso A, et al. A review of indocyanine green fluorescent imaging in surgery[J]. Int J Biomed Imaging, 2012, 2012: 940585.DOI: 10.1155/2012/940585.
[16]	Schols RM, Bouvy ND, van Dam RM, et al. Advanced intraoperative imaging methods for laparoscopic anatomy navigation: an overview[J]. Surg Endosc, 2013, 27(6): 1851-1859.DOI: 10.1007/s00464-012-2701-x.
[17]	黄昌明, 梁寒, 郑朝辉, 等. 吲哚菁绿导航腹腔镜胃癌根治术的应用实践[J]. 中国肿瘤临床, 2024, 51(13): 663-669.DOI: 10.12354/j.issn.1000-8179.2024.20240442.
[18]	Aoki T, Yasuda D, Shimizu Y, et al. Image-guided liver mapping using fluorescence navigation system with indocyanine green for anatomical hepatic resection[J]. World J Surg, 2008, 32(8): 1763-1767.DOI: 10.1007/s00268-008-9620-y.
[19]	张思成, 周大臣, 侯辉, 等. 基于ICG-R15的肝细胞型肝癌肝切除术后肝衰竭的列线图临床预测模型[J]. 安徽医科大学学报, 2023, 58(9): 1593-1598.DOI: 10.19405/j.cnki.issn1000-1492.2023.09.026.
[20]	王兵济, 司安锋, 嵇惠宇, 等. 术中残肝吲哚菁绿试验对肝切除术后肝功能衰竭的预测价值及预后相关性的研究[J]. 临床肿瘤学杂志, 2021, 26(12): 1119-1126.DOI: 10.3969/j.issn.1009-0460.2021.12.011.
[21]	王重, 岳振东, 赵洪伟, 等. 吲哚菁绿15分钟滞留率对肝癌合并门静脉高压症患者经颈静脉肝内门体分流术后肝性脑病发生风险的预测价值[J]. 临床肝胆病杂志, 2020, 36(9): 1994-1997.DOI: 10.3969/j.issn.1001-5256.2020.09.017.
[22]	王小明, 胡明华, 王冠男, 等. ICG-R15联合三维可视化技术用于巨块型肝癌治疗决策22例分析[J]. 中国实用外科杂志, 2019, 39(7): 737-738.DOI: 10.19538/j.cjps.issn1005-2208.2019.07.24.
[23]	江俊杰, 张焕庆, 胡智明. 吲哚菁绿荧光显像技术在肝脏肿瘤诊治中的应用[J]. 中华普通外科杂志, 2020, 35(3): 270-272.DOI: 10.3760/cma.j.cn113855-20190928-00577.
[24]	Liu B, Liu T, Su M, et al. Improving the surgical effect for primary liver cancer with intraoperative fluorescence navigation compared with intraoperative ultrasound[J]. Med Sci Monit, 2019, 25: 3406-3416.DOI: 10.12659/MSM.916423.
[25]	Piccolo G, Barabino M, Diana M, et al. Application of indocyanine green fluorescence as an adjuvant to laparoscopic ultrasound in minimally invasive liver resection[J]. J Laparoendosc Adv Surg Tech A, 2021, 31(5): 517-523.DOI: 10.1089/lap.2020.0895.
[26]	Achterberg FB, Bijlstra OD, Slooter MD, et al. ICG-fluorescence imaging for margin assessment during minimally invasive colorectal liver metastasis resection[J]. JAMA Netw Open, 2024, 7(4): e246548.DOI: 10.1001/jamanetworkopen.2024.6548.
[27]	Ishizawa T, Fukushima N, Shibahara J, et al. Real-time identification of liver cancers by using indocyanine green fluorescent imaging[J]. Cancer, 2009, 115(11): 2491-2504.DOI: 10.1002/cncr.24291.
[28]	夏桂辉, 贾昌俊, 徐锋, 等. 吲哚菁绿荧光成像技术在肝癌切除术中识别微小癌灶的价值[J]. 中国医科大学学报, 2020, 49(10): 899-906.DOI: 10.12007/j.issn.0258-4646.2020.10.007.
[29]	岳珂珂, 吴大帅, 黄运德, 等. 吲哚菁绿荧光成像技术在巴塞罗那肝癌分期B期肝细胞肝癌行腹腔镜肝切除术中的应用[J]. 肿瘤基础与临床, 2024, 37(4): 417-420.DOI: 10.3969/j.issn.1673-5412.2024.04.012.
[30]	李博, 刘竞芳, 鲍金鹏, 等. 三维可视化联合吲哚菁绿荧光影像技术在51例原发性肝癌腹腔镜切除术中的应用价值[J]. 山东大学学报(医学版), 2022, 60(3): 83-88.DOI: 10.3969/j.issn.1006-6586.2023.14.028.
[31]	王天一, 朱玉峰, 孙淼, 等. 三维重建联合吲哚菁绿术中导航在肝癌诊断和治疗中的应用[J]. 吉林大学学报(医学版), 2021, 47(4): 1014-1021.DOI: 10.13481/j.1671-587X.20210427.
[32]	陈少华, 周林, 李晓龙, 等. ICG荧光实时成像技术在特殊部位肝癌腹腔镜肝切除中的安全性及有效性观察[J]. 解放军医学杂志, 2019, 44(4): 336-340.DOI: 10.11855/j.issn.0577-7402.2019.04.12.
[33]	Xu C, Cui X, Jia Z, et al. A meta-analysis of short-term and long-term effects of indocyanine green fluorescence imaging in hepatectomy for liver cancer[J]. Photodiagnosis Photodyn Ther, 2023, 42: 103497.DOI: 10.1016/j.pdpdt.2023.103497.
[34]	中华医学会数字医学分会, 中国医师协会肝癌专业委员会, 中国医师协会外科医师分会微创外科医师委员会, 等. 数字智能联合吲哚菁绿分子荧光导航肝切除术中国专家共识(2021年版)[J]. 中国实用外科杂志, 2022, 42(3): 274-284.DOI: 10.19538/j.cjps.issn1005-2208.2022.03.02.
[35]	Shimada S, Ohtsubo S, Ogasawara K, et al. Macro-and microscopic findings of ICG fluorescence in liver tumors[J]. World J Surg Oncol, 2015, 13: 198.DOI: 10.1186/s12957-015-0615-5.
[36]	Wang H, Li X, Tse BW, et al. Indocyanine green-incorporating nanoparticles for cancer theranostics[J]. Theranostics, 2018, 8(5): 1227-1242.DOI: 10.7150/thno.22872.
[37]	李天博, 高磊, 王江宁. 包裹吲哚菁绿的靶向脂粒在肝癌骨转移诊疗中的应用[J]. 实用医学杂志, 2020, 36(5): 581-585.DOI: 10.3969/j.issn.1006-5725.2020.05.007.
[38]	孙丽晶. ICG键接环糊精-依托泊苷包合物对原位肝癌小鼠的抑瘤效果研究[D]. 昆明: 昆明理工大学, 2022.DOI: 10.27200/d.cnki.gkmlu.2022.000852.
[39]	van Vledder MG, de Jong MC, Pawlik TM, et al. Disappearing colorectal liver metastases after chemotherapy: should we be concerned?[J]. J Gastrointest Surg, 2010, 14(11): 1691-1700.DOI: 10.1007/s11605-010-1348-y.
[40]	Makuuchi M, Torzilli G, Machi J. History of intraoperative ultrasound[J]. Ultrasound Med Biol, 1998, 24(9): 1229-1242.DOI: 10.1016/s0301-5629(98)00112-4.
[41]	张静漪, 罗燕. 术中腔镜超声引导下经膈肌入路行胸腔下膈顶小肝癌切除1例[J]. 中国医学影像学杂志, 2021, 29(4): 378, 389.DOI: 10.3969/j.issn.1005-5185.2021.04.022.
[42]	周超毅, 马金良, 荚卫东, 等. 实时超声导航下解剖性肝段切除在原发性肝癌治疗中的应用及疗效分析[J]. 中国普通外科杂志, 2017, 26(1): 6-12.DOI: 10.3978/j.issn.1005-6947.2017.01.002.
[43]	侯宝华, 简志祥, 孙建, 等. B型超声检查在肝癌切除术中的临床应用[J]. 南方医科大学学报, 2007, 27(7): 1039-1040.DOI: 10.3321/j.issn: 1673-4254.2007.07.036.
[44]	杨见青, 雷国龙, 王巧凤, 等. 二维斑点追踪超声显像联合右心声学造影对肺动脉压正常的慢性阻塞性肺疾病患者右心室功能的评估价值[J]. 现代生物医学进展, 2024, 24(17): 3251-3255.DOI: 10.13241/j.cnki.pmb.2024.17.010.
[45]	Lucchese AM, Kalil AN, Schwengber A, et al. Usefulness of intraoperative ultrasonography in liver resections due to colon cancer metastasis[J]. Int J Surg, 2015, 20: 140-144.DOI: 10.1016/j.ijsu.2015.06.053.
[46]	Li H, Shi M, Long X, et al. Contrast-enhanced intraoperative ultrasound improved hepatic recurrence-free survival in initially unresectable colorectal cancer liver metastases[J]. Dig Liver Dis, 2025, 57(2): 467-476.DOI: 10.1016/j.dld.2024.09.009.
[47]	Chen JY, Dai HY, Li CY, et al. Improved sensitivity and positive predictive value of contrast-enhanced intraoperative ultrasound in colorectal cancer liver metastasis: a systematic review and meta-analysis[J]. J Gastrointest Oncol, 2022, 13(1): 221-230.DOI: 10.21037/jgo-21-881.
[48]	Hoareau J, Venara A, Lebigot J, et al. Intraoperative contrast-enhanced ultrasound in colorectal liver metastasis surgery improves the identification and characterization of nodules[J]. World J Surg, 2016, 40(1): 190-197.DOI: 10.1007/s00268-015-3269-0.
[49]	杨兴广, 成剑文, 许阳, 等. 术中超声造影在肝脏恶性肿瘤手术中的应用价值[J]. 中国普通外科杂志, 2024, 33(7): 1051-1058.DOI: 10.7659/j.issn.1005-6947.2024.07.004.
[50]	于波洋, 于雷, 周洁宏. 超声造影在肝癌射频消融术中的应用价值[J]. 中国老年学杂志, 2013, 33(5): 1196-1197.DOI: 10.3969/j.issn.1005-9202.2013.05.107.
[51]	Shah AJ, Callaway M, Thomas MG, et al. Contrast-enhanced intraoperative ultrasound improves detection of liver metastases during surgery for primary colorectal cancer[J]. HPB, 2010, 12(3): 181-187.DOI: 10.1111/j.1477-2574.2009.00141.x.
[52]	李凯, 曾庆劲, 郑荣琴, 等. 导航引导和导航超声造影辅助消融超声显示困难肝癌[J]. 中山大学学报(医学科学版), 2012, 33(4): 549-552.DOI: 10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2012.0134.
[53]	王曦, 程朋, 何芬, 等. 超声造影引导下微波消融在常规超声显示困难小肝癌中的应用[J]. 临床肝胆病杂志, 2018, 34(8): 1697-1701.DOI: 10.3969/j.issn.1001-5256.2018.08.021.
[54]	娄丽平, 张灵巧, 刘海潮. 超声造影联合混合现实技术在腹腔镜解剖性肝切除术中的应用效果[J]. 解放军医学杂志, 2023, 48(10): 1208-1213.DOI: 10.11855/j.issn.0577-7402.0302.2023.0801.
[55]	周怀明, 董鑫鑫, 邹璐璐. 3D超声融合成像导航技术联合实时超声造影在原发性小肝癌微波消融术中的应用研究[J]. 临床和实验医学杂志, 2024, 23(9): 991-995.DOI: 10.3969/j.issn.1671-4695.2024.09.025.
[56]	高军喜, 韩伟, 谷昊, 等. 超声造影联合实时影像虚拟导航系统在困难肝癌射频消融治疗应用[J]. 中国临床医学影像杂志, 2020, 31(7): 495-499.DOI: 10.12117/jccmi.2020.07.010.
[57]	吴哲境, 李敬东, 熊永福, 等. 吲哚菁绿在解剖性肝切除术中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(1): 25-29.DOI: 10.3877/cma.j.issn.2095-3232.2025002.

Please choose a citation manager

Content to export