Near-infrared Intraoperative Imaging of Thoracic Sympathetic Nerves: From Preclinical Study to Clinical Trial.
Near-infrared Intraoperative Imaging of Thoracic Sympathetic Nerves: From Preclinical Study to Clinical Trial.
复制标题
胸交感神经的近红外术中成像：从临床前研究到临床试验
作者：
He K;Zhou J;Yang F;Chi C;Li H;Mao Y;Hui B;Wang K;Tian J;Wang J
交感神经系统控制和调节心脏和其他器官的活动。交感神经系统功能障碍导致疾病。因此，术中胸交感神经（ITSN）的实时成像对诊断和治疗具有重要的临床意义。本实验研究的目的是评价吲哚菁绿色（ICG）术中ITSN的可行性和有效性。方法：用ICG对10只家兔进行ITSN，以确定其可行性。将动物分为两组。一组家兔接受相同剂量的ICG，但观察时间不同。另一组给予不同剂量的ICG，但同时观察。在所有家兔的感兴趣区域测量信号背景比（SBR）。此外，在2015年7月至2016年6月期间，15例连续肺结节患者在术前24小时静脉注射ICG，并接受近红外（NIR）荧光成像（FI）胸腔镜手术。采用自行研制的新型近红外和白光双通道胸腔镜系统。计算胸交感神经SBRs。结果如下：在临床前研究中，我们能够使用ITSN和ICG精确识别每只家兔脊柱两侧的第二（T2）至第五（T5）胸神经节。此外，我们还探讨了SBR与ICG注射时间和剂量的关系。使用新型双通道胸腔镜系统，我们能够定位从星状神经节（SG）到第六胸神经节（T6）的神经节，以及所有患者中这些神经节之间的链，SBR值为3.26（标准差：0.57）。病理结果证实了我们的发现。结论：在近红外胸腔镜手术中，ICG FI可用于胸交感神经的鉴别。该技术可能取代肋骨导向方法作为标测胸交感神经的标准实践。
The sympathetic nervous system controls and regulates the activities of the heart and other organs. Sympathetic nervous system dysfunction leads to disease. Therefore, intraoperative real-time imaging of thoracic sympathetic nerves (ITSN) would be of great clinical significance for diagnosis and therapy. The aim of this experimental study was to evaluate the feasibility and validity of intraoperative ITSN using indocyanine green (ICG). Methods: ITSN using ICG was performed on 10 rabbits to determine its feasibility. Animals were allocated to two groups. The rabbits in one group received the same dose of ICG, but were observed at different times. The rabbits in the other group were administered different doses of ICG, but were observed at the same time. Signal to background ratio (SBR) was measured in regions of interest in all rabbits. Furthermore, fifteen consecutive patients with pulmonary nodules were intravenously injected with ICG 24 h preoperatively and underwent near-infrared (NIR) fluorescence imaging (FI) thoracoscopic surgeries between July 2015 and June 2016. A novel self-developed NIR and white-light dual-channel thoracoscope system was used. SBRs of thoracic sympathetic nerves were calculated in all patients. Results: In the preclinical study, we were able to precisely recognize each rabbit's second (T2) to fifth (T5) thoracic ganglia on both sides of the spine using ITSN with ICG. In addition, we explored the relationship between SBR and the injection time of ICG and that between SBR and the dose of ICG. Using the novel dual-channel thoracoscope system, we were able to locate the ganglia from the stellate ganglion (SG) to the sixth thoracic ganglion (T6), as well as the chains between these ganglia in all patients with a high SBR value of 3.26 (standard deviation: 0.57). The pathological results confirmed our findings. Conclusion: We were able to use ICG FI to distinguish thoracic sympathetic nerves during NIR thoracoscopic surgery. The technique may replace the rib-oriented method as standard practice for mapping the thoracic sympathetic nerves.