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吲哚氰绿介导的近红外光技术在微小肝脏肿瘤识别、切缘界定和精准手术导航的应用

Application of indocyanine green-fluorescent imaging technique in planning resection line and real-time surgical navigation in small hepatocellular carcinoma

摘要:

目的 探讨吲哚氰绿(ICG)介导的近红外光技术在微小肝脏肿瘤识别、切缘界定和精准导航手术的价值.方法 2015年3月至9月南方医科大学珠江医院肝胆一科共收治11例微小肝脏肿瘤患者,男性5例,女性6例,年龄39 ~ 70岁,平均(55±10)岁;原发性肝癌9例,转移性肝癌2例.术中使用ICG介导的近红外光技术对肿物进行识别、边缘界定和导航手术,术后对肿瘤进行大小测量、荧光分型、病理检查.符合正态分布的计量资料通过两独立样本t检验进行统计学分析.结果 术中ICG分子荧光发现病灶15个,其中7个病灶通过肉眼观察、扪诊和ICG介导的近红外光技术均能发现;6个病灶仅通过ICG介导的近红外光技术识别,其中有4个卫星病灶在术前影像检查、术中肉眼观察、触摸均未发现;另外2例病灶虽然术前发现CT下有异常,但由于位置较深(距离肝脏表面>1.5 cm),肉眼观察、扪诊和ICG介导的近红外光技术检查均未能发现,切开肝实质1 cm后,ICG介导的近红外光技术识别肿瘤.15个病灶均经ICG分子荧光边界定界.切除肿瘤后,经荧光再测和病理检测,均获得了R0切缘.15个病灶分中,全荧光型7个,其中高分化肝癌5个,肝硬化结节2个;部分荧光型4个,其中中分化肝癌3个,高分化肝癌1个;环形荧光型4个,其中低分化肝癌2个,转移性肝癌2个.术前CT测量11个病灶的最大径(1.7±0.2)cm,术中ICG分子荧光测量最大径(1.7±0.3)cm,差异无统计学意义(t=-0.188,P>0.05).结论 ICG介导的近红外光技术在术中对微小肝脏肿瘤的识别、切缘界定、精准手术导航有重要价值.

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abstracts:

Objective To explore the value of near-infrared technology guided by indolecyanine green(ICG) in planning resection line and real-time surgical navigation in small liver cancer.Methods From March to September 2015,11 patients with hepatic tumors received hepatectomy were treated in First Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University.There were 5 male and6 female patients with average age of (55 ± 10)years (range 39-70 years).Among whom,there were 9cases with hepatocellular carcinoma and 2 cases with colorectal cancer.A near-infrared light camera system was used to detect the liver surfaces before resection,and to plan resection line and surgical specimens.A student's t test was used to compare continuous parametric variables.Results The ICG-flnorescent imaging and histological examination had been used in the 15 lesions of the 11 patients.Among the 15 lesions,7 lesions were detected by visual inspections,palpation and ICG-fluorescent imaging,6 lesions were identified only by ICG-fluorescent imaging,2 lesions were detected only by ICG-fluorescent imaging after resection.Results of pathologic examination indicated that the total fluorescent type include 5 well differentiated hepatocellular carcinoma and 2 cirrhotic nodule;the partial fluorescent type include3 moderately differentiated hepatocellular carcinomas and 1 well differentiated hepatocellular carcinomas;the rim fluorescent type included 2 liver metastatic carcinoma and 2 poorly differentiated hepatocellular carcinomas.The average diameter of the tumor size measured by CT was (1.7 ± 0.2)cm,while the average diameter measured by ICG-fluorescent imaging was (1.7 ± 0.3) cm(t =-0.188,P > 0.05).Conclusion Near-infrared technology guided by ICG has important value in planning resection line and real-time surgical navigation in small liver cancer.

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作者: 方驰华 [1] 梁洪玻 [1] 迟崇巍 [2] 陶海粟 [1] 方程 [1] 祝文 [1] 莫志康 [1] 杨剑 [1] 项楠 [1]
第一作者: 方驰华
期刊: 《中华外科杂志》2016年54卷6期 444-450页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2016.06.011
发布时间: 2016-07-05
基金项目:
国家高技术研究发展(863)计划资助项目 国家自然科学基金重点资助项目 广东省重大科技专项资助项目 National High-tech R&D Program of China (863 Program) National Natural Science Foundation of China (Key Program) National Science and Technology Major Project of Guangdong Province of China
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