Evaluation of hepatic perfusion in the liver graft using fluorescence imaging with indocyanine green.
Evaluation of hepatic perfusion in the liver graft using fluorescence imaging with indocyanine green.
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DOI：
10.1016/j.ijscr.2015.07.031
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发表时间：
2015
影响因子：
0.6
通讯作者：
Kokudo N
中科院分区：
文献类型：
--
作者：
Kawaguchi Y;Akamatsu N;Ishizawa T;Kaneko J;Arita J;Sakamoto Y;Hasegawa K;Kokudo N
门静脉血栓形成是肝移植术后的严重并发症之一。吲哚菁绿色（ICG）荧光成像可以清楚地显示移植肝表面的灌注受损或充血区域。ICG-荧光成像可以在肝移植过程中可视化肝脏灌注受损的区域，以及重建血管的肝血流可视化和静脉闭塞区域的评估。门静脉血栓形成（PVT）是肝移植术后的严重并发症之一，据报道发生率为2%~ 13%。PVT损害了移植物的血液灌注并导致移植物功能障碍。一位60岁女性因慢性丙型肝炎相关的终末期肝病接受了左肝移植的活体供肝移植。再灌注后，进行吲哚菁绿色（ICG）-荧光成像以确认移植物灌注，其指出第4节段表面上的灌注不足。术中超声检查显示第4段门静脉血栓，通过肝素化生理盐水冲洗成功清除。绝大多数PVT患者发生移植物衰竭，导致再次移植。这增强了术后和术中监测PVT的重要性。然而，在手术过程中识别PVT的方式主要限于术中超声。ICG-荧光成像可以在LT期间真实的时间内可视化由于PVT而导致的肝脏灌注受损的区域，以及重建血管的肝脏流动的可视化和静脉闭塞区域的评估。ICG-荧光成像可以简单地进行单次ICG注射，预计将有潜在的作用，以提高LT的安全性。
Portal vein thrombosis after liver transplantation is one of serious complications. Indocyanine green (ICG)-fluorescence imaging can visualize the impaired perfusion or congestive area on the liver graft surface clearly. ICG-fluorescence imaging can visualize regions with impaired hepatic perfusion during liver translantation in addition to visualization of hepatic flows of reconstructed vessels and evaluation of regions with venous occlusion. Portal vein thrombosis (PVT) after liver transplantation (LT) is one of serious complications and reportedly ranges from 2% to 13%. PVT impairs the blood perfusion to the grafts and causes the graft dysfunction. A 60-year-old female underwent living-donor LT with the left liver graft for end-stage liver disease related to chronic hepatitis C. After reperfusion, Indocyanine green (ICG)-fluorescence imaging was performed to confirm the graft perfusion, which pointed out an insufficient perfusion on the surface of segment 4. Following intraoperative ultrasonography revealed thrombus in the portal vein of segment 4, which was successfully removed by heparinized saline flush. The most of patients with PVT developed graft failure and resulted in retransplantation. This enhances the importance of the surveillance for PVT in the postoperative period as well as the intraoperative period. However, the modality to identify PVT during surgery is limited mainly to intraoperative ultrasound. ICG-fluorescence imaging can visualize regions with impaired hepatic perfusion due to PVT in real time during LT in addition to visualization of hepatic flows of reconstructed vessels and evaluation of regions with venous occlusion. ICG-fluorescence imaging can be simply performed with single ICG injection and is expected to have potential roles to enhance the safety of LT.