吲哚菁绿荧光实时成像技术在机器人肝切除中的初步应用(附二例报告)

摘要

目的 探讨吲哚菁绿荧光实时成像技术在机器人辅助腹腔镜肝切除中应用的可行性.方法 回顾性分析华中科技大学同济医学院附属同济医院2017年8月使用吲哚菁绿荧光实时成像技术行机器人肝切除的2例病人的临床资料.病例1原发性肝癌拟行机器人辅助腹腔镜肝8段切除,术前超声引导下经皮肝穿刺肝8段门静脉分支,注射吲哚菁绿染色剂;术中利用PINPOINT荧光显象系统确定切除边界并引导离断肝实质.病例2肝右叶海绵状血管瘤,术中经门静脉注入吲哚菁绿染色剂,对血管瘤进行负染,确定血管瘤边界,引导离断肝脏实质.结果 病例1肝脏8段包膜及肝实质在PINPOINT系统中均呈现绿色荧光,与周围肝组织界限清晰,离断肝实质过程中可根据荧光指引肝切除平面,完整切除肝脏8段.病例2肝血管瘤无荧光染料滞留,与周围呈绿色荧光的肝组织界限清晰,在荧光指引下准确找到血管瘤包膜,并完整剜除.上述病人术中无大出血,术后恢复顺利,无并发症发生.结论 吲哚菁绿荧光实时成像系统应用于机器人辅助腹腔镜肝切除手术是安全有效的.%Objective To investigate the clinical application of indocyanine green (ICG) flurescence imaging in robotic-assisted laparoscopic hepatectomy (RALH).Methods The clinical data of 2 cases of RALH using ICG flurescence imaging were retrospectively analyzed.For case 1,a patient with HCC underwent RALH for the segment 8.ICG was injected into the portal vein branch of the segment 8 by ultrasound-guided percutaneous transhepatic portal vein puncture before surgery.The boundary of the segment 8 was determined by ICG fluorescence imaging system.Parenchymal transection was intermittently monitored by ICG fluorescence imaging system (PINPOINT).For case 2,a patients with hepatic cavernous hemangioma received limited liver resection.The ICG was injected into portal vein directly during surgery.The boundary of tumor was detected and the parenchyma was transected under PINPOINT guidance.Results In case 1,the surface and parenchyma of the segment 8 showed green fluorescence in PINPOINT system,and the boundary was very clear.Resection plane was guided by the fluorescence of parenchyma.The segment 8 was completely resected.In case 2,the normal liver tissue showed green fluorescence and the hepatic cavernous hemangioma did not,thus the boundary of hemangioma was defined and the tumor was totally removed.No intraoperative massive hemorrhage and postoperative complication occurred on those patients.Conclusions The application of ICG fluorescence real-time imaging system in RALH is safe and effective.