Liver transection using indocyanine green fluorescence imaging and hepatic vein clamping
Liver transection using indocyanine green fluorescence imaging and hepatic vein clamping
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DOI：
10.1002/bjs.10499
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发表时间：
2017-06-01
影响因子：
9.6
通讯作者：
Tanaka, N.
中科院分区：
文献类型：
--
作者：
Kawaguchi, Y.;Nomura, Y.;Tanaka, N.
背景：三维（3D）成像通过估计门静脉和肝静脉区域的肝脏体积，促进了肝切除和肝静脉切除。然而，三维成像不能用于实时导航以确定肝横断线。本研究评估了肝静脉夹持下吲哚菁绿（ICG）荧光成像在肝横断术中的导航价值。方法：对2012 - 2013年连续行肝切除术并切除肝大静脉的患者，夹持静脉注射ICG后进行ICG荧光成像评价。利用亮度分析软件计算非静脉闭塞区（FINon）、静脉闭塞区（FIVO）和缺血区（FIIS）的区域荧光强度（FI）值。结果：21例患者分别行有限切除10例、单节段切除4例和半肝切除7例，均切除肝大静脉。静脉闭塞的中位肝脏体积为80（范围30-458）ml。荧光成像显示静脉闭塞区域为比非静脉闭塞区域FI更低的区域，静脉注射ICG后缺血区域为无荧光区域。FIIS/FINon的中位数低于FIVO/FINon的中位数（0.22 vs 0.59; P = 0.002）。没有在医院或30天内死亡，只有一个主要并发症。结论：肝静脉夹持的ICG荧光成像可显示非静脉闭塞区、静脉闭塞区和缺血区。该技术可通过术中导航引导肝切除术，提高肝切除术的安全性和准确性。
Background: Three-dimensional (3D) imaging has facilitated liver resection with excision of hepatic veins by estimating the liver volume of portal and hepatic venous territories. However, 3D imaging cannot be used for real-time navigation to determine the liver transection line. This study assessed the value of indocyanine green (ICG) fluorescence imaging with hepatic vein clamping for navigation during liver transection.Methods: Consecutive patients who underwent liver resection with excision of major hepatic veins between 2012 and 2013 were evaluated using ICG fluorescence imaging after clamping veins and injecting ICG. Regional fluorescence intensity (FI) values of non-veno-occlusive regions (FINon), veno-occlusive regions (FIVO) and ischaemic regions (FIIS) were calculated using luminance analysing software.Results: Of the 21 patients, ten, four and seven underwent limited resection, monosegmentectomy/sectionectomy and hemihepatectomy respectively, with excision of major hepatic veins. Median veno-occlusive liver volume was 80 (range 30-458) ml. Fluorescence imaging visualized veno-occlusive regions as territories with lower FI compared with non-veno-occlusive regions, and ischaemic regions as territories with no fluorescence after intravenous ICG injection. Median FIIS/FINon was lower than median FIVO/FINon (0.22 versus 0.59; P = 0.002). There were no deaths in hospital or within 30 days, and only one major complication.Conclusion: ICG fluorescence imaging with hepatic vein clamping visualized non-veno-occlusive, veno-occlusive and ischaemic regions. This technique may guide liver transection by intraoperative navigation, enhancing the safety and accuracy of liver resection.