Application of indocyanine green fluorescence imaging in hepatectomy of complex and difficult hepatocellular carcinoma

doi:10.3877/cma.j.issn.1674-3946.2023.03.022

Abstract

Abstract:

Objective

To investigate the efficacy of indocyanine green（ICG）fluorescence imaging in hepatectomy of complex and difficult hepatocellular carcinoma（HCC）.

Methods

A total of 80 HCC patients who underwent complex and difficult hepatectomy from January 2018 to October 2022 were retrospectively selected as subjects. According to different tumor localization and hepatectomy plane determination scheme，the patients were divided into conventional group and ICG fluorescence group，with 40 cases in each group. Conventional group：Routine laparoscopic hepatectomy（LH）；ICG fluorescence group：LH was completed under the guidance of ICG fluorescence development. Data was processed by SPSS 22.0. Perioperative relevant indicators，liver function indicators and other measurement data were represented by（

x ˉ

±s），independent t test；Statistical data such as postoperative complications were represented by［cases（%）］，χ² test was performed. P<0.05 was considered statistically significant.

Results

Operation time，intraoperative blood loss，hilar occlusion time and postoperative hospital stay in ICG fluorescence group were significantly lower than those in conventional group，and R0 margin rate was significantly higher than that in conventional group，with statistical significance（P<0.05）. There was no significant difference in postoperative anal exhaust time，postoperative extubation time and postoperative complication incidence between the two groups（P>0.05）. There was no interaction between time and method at the levels of ALB，TBIL，AST and ALT（P>0.05），while the main effect of time and method was significant at the levels of ALB，TBIL，AST and ALT（P<0.05）.

Conclusion

The application of ICG fluorescence imaging in hepatectomy of complex and difficult hepatocellular carcinoma is safe and effective. It can not only effectively shorten the operation time and hilar occlusion time，reduce intraoperative injury and improve R0 resection rate，but also benefit the postoperative recovery of patients and the recovery of liver function，which is worthy of widespread clinical application.

Key words: Carcinoma, Hepatocellular, Hepatectomy, Indocyanine Green, Fluorescence Imaging

Kewen Liu, Zhidong Pang. Application of indocyanine green fluorescence imaging in hepatectomy of complex and difficult hepatocellular carcinoma[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(03): 319-322.

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References 13

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组别	例	性别	年龄 (岁)	术前并发症
组别	例	男/女	年龄 (岁)	有/无
常规组	40	25/15	55.1±10.4	30/10
ICG荧光组	40	27/13	54.6±10.9	32/8
t/χ²值		0.220	0.210	0.287
P值		0.639	0.417	0.592
组别	例	肿瘤直径 (cm)	肿瘤位置	Child-Pugh分级
组别	例	肿瘤直径 (cm)	A/B/C/D/E/F	A/B(经药物治疗后达A级)
常规组	40	4.6±1.2	6/14/12/2/1/5	34/6
ICG荧光组	40	4.4±1.5	5/12/13/3/2/5	36/4
t/χ²值		0.637	0.818	0.457
P值		0.263	0.976	0.499

组别	例	性别	年龄 (岁)	术前并发症
组别	例	男/女	年龄 (岁)	有/无
常规组	40	25/15	55.1±10.4	30/10
ICG荧光组	40	27/13	54.6±10.9	32/8
t/χ²值		0.220	0.210	0.287
P值		0.639	0.417	0.592
组别	例	肿瘤直径 (cm)	肿瘤位置	Child-Pugh分级
组别	例	肿瘤直径 (cm)	A/B/C/D/E/F	A/B(经药物治疗后达A级)
常规组	40	4.6±1.2	6/14/12/2/1/5	34/6
ICG荧光组	40	4.4±1.5	5/12/13/3/2/5	36/4
t/χ²值		0.637	0.818	0.457
P值		0.263	0.976	0.499

组别	例	手术时间 (min)	术中出血量 (ml)		肝门阻断时间 (min)		R0切缘 (%)
常规组	40	235.1±45.3	338.4±65.8		56.2±10.3		32(80.0)
ICG荧光组	40	218.6±36.2	302.3±51.5		45.8±9.2		39(97.5)
t/χ²值		1.800	2.732		3.389		4.507
P值		0.038	0.004		0.001		0.034
组别	例	术后肛门排气时间(d)		术后拔管时间 (d)		术后住院时间 (d)
常规组	40	3.1±1.0		3.7±0.7		9.6±2.5
ICG荧光组	40	3.0±0.9		3.6±0.6		8.4±2.1
t/χ²值		0.470		0.686		2.325
P值		0.320		0.247		0.011

组别	例	手术时间 (min)	术中出血量 (ml)		肝门阻断时间 (min)		R0切缘 (%)
常规组	40	235.1±45.3	338.4±65.8		56.2±10.3		32(80.0)
ICG荧光组	40	218.6±36.2	302.3±51.5		45.8±9.2		39(97.5)
t/χ²值		1.800	2.732		3.389		4.507
P值		0.038	0.004		0.001		0.034
组别	例	术后肛门排气时间(d)		术后拔管时间 (d)		术后住院时间 (d)
常规组	40	3.1±1.0		3.7±0.7		9.6±2.5
ICG荧光组	40	3.0±0.9		3.6±0.6		8.4±2.1
t/χ²值		0.470		0.686		2.325
P值		0.320		0.247		0.011

组别	例	时间	ALB(g/L)	TBIL(μmol/L)
常规组	40	T0	42.1±4.1	17.1±6.4
		T3	33.6±3.0	36.4±14.3
		T7	34.8±1.4	25.5±11.3
ICG荧光组	40	T0	41.5±3.8	16.6±6.8
		T3	36.8±3.3	26.1±10.1
		T7	38.5±1.8	19.2±7.4
P值			P_时间=0.038， P_组间=0.045， P_交互=0.273	P_时间=0.029，P_组间=0.041，P_交互=0.876
组别	例	时间	AST(U/L)	ALT(U/L)
常规组	40	T0	30.2±9.7	35.1±16.8
		T3	136.8±31.5	256.8±81.6
		T7	68.3±18.4	108.4±38.3
ICG荧光组	40	T0	30.6±10.2	36.8±16.4
		T3	92.1±36.5	162.1±56.5
		T7	36.8±13.6	86.7±26.9
P值			P_时间=0.011，P_组间=0.020，P_交互=0.574	P_时间=0.008，P_组间=0.025，P_交互=0.908

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