Application Of Indocyanine Green Fluorescence In Thoracoscopic Segmental Pulmonary Surgery

Objective: To analyze the application of indocyanine green fluorescence staining in single-hole thoracoscopic segmental lung resection.Methods: Retrospective analysis was made on the clinical data of 124 patients with pulmonary nodules who underwent single-hole thoracoscopic pulmonary segment resection in the cardiothoracic surgery Department of Yijishan Hospital,the First Affiliated Hospital of Wannan Medical College from January 2021 to June 2022.According to the different display methods of the intersegmental plane selected during the operation,they were divided into two groups.the indocyanine green fluorescence group(36 cases)and the improved swelling collapse method group(88 cases).Preoperatively,the thin-layer CT scan data of all patients were imported into the three-dimensional image analysis system to identify the location of pulmonary nodules,and three-dimensional reconstruction was carried out for anatomical structures such as bronchi,arteries and veins,so as to produce the target bronchi,arteries and veins included in the lung segment to be surgically resected,The preserved intersegmental veins and virtual intersegmental planes were also identified.In the indocyanine green fluorescence method group,after the target pulmonary artery,vein and bronchus were cut off during the operation,indocyanine green was injected into the peripheral vein,and then the fluorescence mode of the fluorescent thoracoscope was turned on to mark the interface between the undeveloped segments.In the modified inflationdeflation method group,Double-lung ventilation was performed to revive the whole lung after accurately cutting off the arteries,veins and bronchi of the target segments,and then single-lung ventilation was performed on the healthy side,until the boundary between target segments was formed to mark.The clinical data of the two groups of patients,such as the occurrence time of the intersegmental plane,the duration of the intersegmental plane,the operation time,the amount of intraoperative bleeding,the time of indwelling catheter after the operation,the length of hospitalization after the operation,and the postoperative complications,were compared and statistically analyzed.Results: Compared with the inflation-deflation method,the appearance time of the intersegmental plane in the fluorescent staining method was significantly shorter [(10.31 ±0.92)s vs(981.36 ± 66.49)s,P<0.001];The operation time was significantly shortened[(90.97 ± 5.58)min vs(120.58 ± 9.04)min,P=0].There was no significant difference between the two groups in the statistics on intraoperative bleeding volume(ml),postoperative catheter placement time(days),postoperative hospital stay(days),and complications including adverse reactions of ICG,pulmonary leakage(continuous leakage(>3 days),pleural effusion,and pulmonary infection.Conclusion: In segmental lung surgery,the intersegmental plane can be displayed quickly,accurately and clearly by using fluorescent staining.Compared with modified inflationdeflation method,the fluorescent staining method can achieve the same surgical effect,and significantly shorten the operation time without serious surgical complications,which is more in line the requirements of the concept of rapid rehabilitation,can provide reliable technical support for the operator,thus has high clinical application value.