Indocyanine green fluorescence-navigated thoracoscopic anatomical segmentectomy.
Indocyanine green fluorescence-navigated thoracoscopic anatomical segmentectomy.
复制标题
DOI：
10.21037/jovs.2017.05.06
复制
发表时间：
2017-01-01
期刊：
影响因子：
--
通讯作者：
Nakagawa, Ken
中科院分区：
文献类型：
--
作者：
Mun, Mingyon;Okumura, Sakae;Nakagawa, Ken
背景：利用三维计算机断层扫描（3D-CT）重建和吲哚菁绿荧光（ICGF）导航技术评价胸腔镜解剖节段切除术（TS-S）的可行性和疗效。方法：对15例原发性肺癌和5例转移性肺癌进行了20例TS-S手术。术前我们评估目标肺段动脉，并使用3D-CT重建创建虚拟节段间平面。术中分离靶段动脉和支气管，全身静脉注射吲哚青绿（ICG, 0.25 mg/kg）后，采用红外胸腔镜（KARL STORZ Endoskope Japan K.K., Tokyo, Japan）观察非靶段（NTS）的ICGF。我们用电针标出目标和NTS之间的边界，并沿着这个边界用电针或订书钉划分肺实质。靶和NTS之间的对比强度被量化为对比指数（CI），并随时间进行比较。结果：ICGF为19例（95%）患者提供了足够清晰和持续时间的肺表面标记。所有患者均成功行TS-S。平均手术时间186 min (90 ~ 310 min)，平均失血量30 mL （0 ~ 107 mL）。ICG注射后20 s （10 ~ 100 s）出现分界线，ICGF持续180 s （90 ~ 300 s）。CI在ICGF出现后30 s达到峰值，并随时间下降。有效对比持续70秒（30-116秒），足以标记出分界线。该方法无并发症发生。结论：ICGF导航是一种安全有效的TS-S治疗技术。
BACKGROUND: To evaluate the feasibility and efficacy of thoracoscopic anatomical segmentectomy (TS-S) using three-dimensional computed tomography (3D-CT) reconstruction and indocyanine green-fluorescence (ICGF) navigation.METHODS: Twenty TS-S procedures were performed for 15 primary lung cancers and 5 metastatic lung tumors. Preoperatively we evaluated the target segmental pulmonary artery and created a virtual intersegmental plane using 3D-CT reconstruction. Intraoperatively, the target segmental artery and bronchus were divided, and after intravenous systemic injection of indocyanine green (ICG, 0.25 mg/kg), ICGF of the non-target segments (NTS) was observed using infrared thoracoscopy (KARL STORZ Endoskope Japan K.K., Tokyo, Japan). We marked the border between target and NTS with electrocautery and divided the lung parenchyma along this border using electrocautery or staples. Strength of contrast between target and NTS was quantified as contrast index (CI) and compared over time.RESULTS: ICGF provided demarcation of sufficient clarity and duration to mark the lung surface in 19 patients (95%). TS-S was successfully performed in all patients. Mean operative duration was 186 min (90-310 min) and mean blood loss was 30 mL (0-107 mL). Demarcation appeared 20 s (10-100 s) after injection of ICG, and ICGF lasted 180 s (90-300 s). CI peaked 30 s after the appearance of ICGF and decreased over time. Effective contrast continued for 70 s (30-116 s), which was sufficient to mark the line of demarcation. There were no complications attributable to this method.CONCLUSIONS: ICGF navigation is a safe and effective technique for TS-S.