Clinical application of indocyanine green fluorescence imaging in laparoscopic lymph node dissection for intrahepatic cholangiocarcinoma: A pilot study (with video)
Clinical application of indocyanine green fluorescence imaging in laparoscopic lymph node dissection for intrahepatic cholangiocarcinoma: A pilot study (with video)
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吲哚菁绿荧光成像在腹腔镜肝内胆管癌淋巴结清扫术中的临床应用：初步研究（附视频）
DOI：
10.1016/j.surg.2021.09.032
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Wanguang Zhang
中科院分区：
文献类型：
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作者：
Yuxin Zhang;Yujie Zhang;Jinghan Zhu;Haisu Tao;Huifang Liang;Yi-Fa Chen;Zhanguo Zhang;Jianping Zhao;Wanguang Zhang
肝内胆管细胞癌是一种以淋巴结转移为特征的高致死性恶性肿瘤。本研究旨在评价吲哚菁绿色荧光显像淋巴引流的有效性，并评估其在腹腔镜肝内胆管癌淋巴结清扫术中的临床应用，回顾了2018年10月至2021年1月期间所有行腹腔镜左肝切除术和淋巴结清扫术的肝内胆管癌患者。根据染色技术将患者分为吲哚菁绿色组和非肝内胆管癌组，38例左半肝内胆管癌患者中，20例接受了肝内胆管癌示踪剂引导的腹腔镜左肝根治性切除术; 12例手术成功（吲哚菁绿色组）。同期，18例患者接受传统腹腔镜切除术（对照组）。他们的术中因素相当，术后30天的术后并发症发生率或严重程度无差异（P > 0.05）。在吲哚菁绿色组中，获得更多的淋巴结（平均值[范围：7.0 [6.0-8.0 vs 3.5 P < .001]），并且确认的病理淋巴结的比例更高（75.0%，66.7%-87.5% vs 40%，33.3%-50.0%，P < .001）。肝内胆管癌组8、12站ICG阳性率均为100%，13、7站ICG阳性率分别为75%和91.7%，表明吲哚菁绿色荧光显像系统用于淋巴结示踪是可行、安全、有效的。它可以用来确定区域淋巴引流模式，并帮助确定肝内胆管癌患者的淋巴结清扫范围。
Intrahepatic cholangiocarcinoma is a highly lethal malignancy characterized by lymph node metastasis. This study aimed to evaluate the efficacy of indocyanine green fluorescence for visualization of lymphatic drainage and to assess its clinical application during laparoscopic lymph node dissection for intrahepatic cholangiocarcinoma.All patients with intrahepatic cholangiocarcinoma who underwent laparoscopic left hepatectomy and lymph node dissection between October 2018 and January 2021 were reviewed. The patients were assigned to the indocyanine green group or non-intrahepatic cholangiocarcinoma group based on the staining technique used.Of 38 patients with left hemiliver intrahepatic cholangiocarcinoma, 20 underwent intrahepatic cholangiocarcinoma tracer-guided laparoscopic radical left hepatectomy; 12 procedures were successful (indocyanine green group). During the same period, 18 patients were treated with traditional laparoscopic resection (control group). Their intraoperative factors were comparable and there were no differences in the incidence or severity of their postoperative complications 30 days after surgery (P > .05). In the indocyanine green group, more lymph nodes were harvested (mean [range: 7.0 [6.0-8.0 vs 3.5 P < .001) and the proportion of confirmed pathologic lymph nodes was higher (75.0%, 66.7%-87.5% vs 40%, 33.3%-50.0%, P < .001). ICG staining was observed in all (12/12, 100%) patients in the intrahepatic cholangiocarcinoma group at stations 8 and 12, and 9 (9/12, 75%) and 10 (11/12, 91.7%) patients at Stations 13 and 7, respectively.The indocyanine green fluorescence imaging system is feasible, safe, and effective for tracing lymph nodes. It can be used to identify regional lymphatic drainage patterns and help define the scope of lymph node dissection in patients with intrahepatic cholangiocarcinoma.