Intraoperative fluorescent imaging using indocyanine green for liver mapping and cholangiography
Intraoperative fluorescent imaging using indocyanine green for liver mapping and cholangiography
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DOI：
10.1007/s00534-009-0197-0
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发表时间：
2010-09-01
影响因子：
3
通讯作者：
Kato, Takashi
中科院分区：
文献类型：
--
作者：
Aoki, Takeshi;Murakami, Masahiko;Kato, Takashi
研究背景：术前影像在肝胆外科中应用广泛，且有很大的帮助。然而，将术前数据转移到术中状态是非常困难的。在肝胆外科领域，外科医生需要术中使用影像数据的解剖学信息来进行安全和精确的手术。我们开发了一种新的利用术中吲哚青绿(ICG)荧光在红外光观测下绘制肝段和胆管造影图的系统。2006年1月至2009年3月，81例肝肿瘤患者接受了肝切除术。在肝脏手术中，在荧光成像系统的观察下，经门静脉注入ICG 1ml。对14例慢性胆囊炎合并胆石症患者施行了腹腔镜胆囊切除术。结果81例患者中，73例(90.1%)成功地识别出肝脏染色的亚段和节段。此外，即使是在肝硬变的背景下，也能得到清晰的肝段标测。荧光胆道造影清晰显示胆总管和胆囊管10例(71.4%)。结论应用该技术可在肝胆外科手术中辨认解剖标志。
Background Preoperative imaging is widely used and extremely helpful in hepatobiliary surgery. However, transfer of preoperative data to a intraoperative situation is very difficult. Surgeons need intraoperative anatomical information using imaging data for safe and precise operation in the field of hepatobiliary surgery. We have developed a new system for mapping liver segments and cholangiograms using intraoperative indocyanine green (ICG) fluorescence under infrared light observation.Method The imaging technique for mapping liver segments and cholangiogram based on ICG fluorescence used an infrared-based navigation system. Eighty one patients with liver tumors underwent hepatectomy from 2006, January to 2009, March. In liver surgery, 1 ml of ICG was injected via the portal vein under observation by the fluorescent imaging system. Fourteen patients were underwent laparoscopic cholecystectomy for chronic cholecystitis with gallstones. In laparoscopic cholecystectomy, 5 ml of ICG was administered intravenously just before operation and the bile duct was observed using the infrared-based navigation system.Result This new technique successfully identified stained subsegments and segments of the liver in 73 of 81 patients (90.1%). Moreover, clear mapping of liver segments was obtained even against a background of liver cirrhosis. Fluorescent cholangiography clearly showed the common bile duct and cystic duct in 10 of 14 patients (71.4%). No adverse reactions to the ICG were encountered.Conclusion Application of this technique allows intra-operative identification of anatomical landmark in hepatobiliary surgery.