A simple and effective technique for identification of intersegmental planes by infrared thoracoscopy after transbronchial injection of indocyanine green
A simple and effective technique for identification of intersegmental planes by infrared thoracoscopy after transbronchial injection of indocyanine green
复制标题
DOI：
10.1016/j.jtcvs.2012.01.079
复制
发表时间：
2012-06-01
影响因子：
6
通讯作者：
Miwa, Mitsuharu
中科院分区：
文献类型：
--
作者：
Sekine, Yasuo;Ko, Eitetsu;Miwa, Mitsuharu
目的：肺段切除术已被认为是肺功能差的早期肺癌患者完全切除的手术选择。然而，肺气肿患者解剖肺段的识别有时是困难的。我们开发了一种术中方法，用于识别肺段间平面与高灵敏度红外荧光成像后，经支气管注射indocyanine绿色。方法：本研究包括10例早期肺癌患者进行胸腔镜肺段切除术。在全身麻醉下，将吲哚菁绿色注射到靶肺段的支气管内。使用吲哚菁绿色荧光内窥镜（Hamamatsu Photonics，Hamamatsu，Japan）识别肺的靶段。确定了节段间的线和平面，并允许切除节段。为了评估手术结果，我们比较了吲哚菁绿色注射组与回顾性对照组10对匹配的患者进行传统的胸腔镜segmentectomy.Results：准确，实时术中检测吲哚菁绿色与红外胸腔镜证实。使用斯台普斯和电烙器安全地进行节段间保留。此外，红外线胸腔镜检查允许在节段切除术后可视化切除节段的任何残留部分。在手术时间、术后胸腔引流持续时间或术后并发症方面，实验吲哚菁绿色组和对照组之间没有差异。吲哚菁绿色组的住院时间短于对照组（P = 0.055）。结论：经支气管吲哚菁绿色注射到相关支气管与使用红外胸腔镜允许识别在胸腔镜肺段切除术的intersegmented线和平面。（《胸血管外科杂志》2012;143：1330-5）
Objective: Pulmonary segmentectomy has been recognized as an operative option for complete resection of early-stage lung cancer in patients with poor pulmonary function. However, identification of anatomic pulmonary segments is sometimes difficult in patients with emphysema. We developed an intraoperative method for identifying intersegmental planes of the lung with high-sensitivity infrared fluorescence imaging after transbronchial injection of indocyanine green.Methods: The study included 10 patients with early-stage lung cancer who underwent thoracoscopic segmentectomy. Under general anesthesia, indocyanine green was injected into the bronchus of target pulmonary segments. The target segments of the lung were identified using the indocyanine green fluorescence endoscope (Hamamatsu Photonics, Hamamatsu, Japan). The intersegmental lines and planes were identified and allowed removal of the segments. To evaluate operative outcomes, we compared the indocyanine green injection group with a retrospective control group with 10 matched-pair patients who underwent traditional thoracoscopic segmentectomy.Results: Accurate, real-time intraoperative detection of indocyanine green with an infrared thoracoscope was confirmed. Sparing of intersegments was safely performed using both staples and electric cautery. Furthermore, infrared thoracoscopy allowed visualization of any residual portion of resected segments after segmentectomy. There was no difference between the experimental indocyanine green and control groups in terms of operative time, duration of postoperative chest drainage, or postoperative complications. Length of stay was shorter in the indocyanine green group than in the control group (P = .055).Conclusions: Transbronchial indocyanine green injection into the relevant bronchus with the use of an infrared thoracoscope allows identification of intersegmental lines and planes during thoracoscopic segmentectomy. (J Thorac Cardiovasc Surg 2012;143:1330-5)