| PurposeIndocyanine green(ICG),as a safe near-infrared fluorescent staining agent,has been preliminarily applied in liver surgery,including intraoperative tumor detection,liver segment boundary detection,biliary tract detection and liver cell function evaluation of transplanted liver.However,the application of ICG fluorescence in guiding anatomic hepatectomy is still in the exploratory stage,including ICG dosage,staining method and indications.ICG fluorescence fusion image(FIGFI)is a computer fusion of common ICG fluorescence signal with specific colors to enhance the fluorescence display and optimize the visual effect.The purpose of this study was to evaluate the clinical value of FIGFI in guiding anatomic hepatectomy for hepatocellular carcinoma(HCC).Materials and methods(1)The clinical data of 11 patients with HCC who underwent precise right hemihepatectomy guided by fusion ICG fluorescence imaging(IGFI)from July 2017 to December 2017 were retrospectively analyzed.Preoperative patients were selected according to inclusion and exclusion criteria.For patients undergoing positive development,1ml ICG(2.5mg /mL)was injected through the right portal vein to develop the right liver in 3d.The left liver was visualized in 3d by peripheralintravenous injection of 1ml ICG(2.5mg /mL)in patients undergoing reverse visualization.During fluorescence imaging of the liver,the liver tissue was separated in real time by fluorescence boundary ultrasound knife for accurate right hepatic resection.(2)A case-control study was conducted to analyze the clinical data of 55 patients with HCC who underwent anatomic hepatectomy in the department of liver surgery of anhui medical university from July 2017 to July 2018.All patients signed the informed consent,in line with the provisions of medical ethics.The FIGFI guiding group included 28 patients undergoing FIGFI guiding anatomic hepatectomy,while the control group included 27 patients undergoing no FIGFI guiding anatomic hepatectomy during the same period.In the FIGFI guiding group,there were 23 males and 5 females,with an average age(54±12)years old.In the control group,22 males and 5 females were aged(58 ± 12).The surgical indicators and postoperative complications of the two groups were compared by t test or chi-square test.Results(1)Ten of the 11 patients(90.9%)had successful staining who underwent precise right hemihepatectomy guided by FIGFI.The negative stainings were applied to8 patients,including 1 failed staining,and the positive stainings were applied to 3patients.ICG fluorescence range of 10 patients in liver surface were consistent with the ischemic line,whose postoperative liver cross-section are clearly demarcation.The mean operation time,blood Loss,postoperative hospital stay,cases of blood transfusion,complication rate,postoperative peak volume of ALT and TB and complication rate were 246 minutes(range,150~345 minutes),241ml(range,100~600 ml),10.4 days(range,6~15 days),0,4/11,346 U/L(114~707 U/L)and 47.1 ?mol/L(21.5 ~ 68.0 ?mol/L).Pathology results of all patients are HCC and negative margins,and microvascular invasion occurred in 8 cases.The average follow-up time of 11 patients was 3.9 months(1~7 months)without death,and recurrence was notedin 1 case.(2)The operative time in the FIGFI guiding group was(245±62)min,which was significantly longer than(198 ± 60)min in the control group(t= 2.857,P <0.05).The rate of intraoperative blood transfusion in the FIGFI group was 7%(2/28),lower than 45%(12/22)in the control group(?2= 10.079;P < 0.05),but there was no significant difference in intraoperative blood loss(P > 0.05).FIGFI guiding postoperative drainage tube drawing time,the highest temperature(6.3 ± 2.4)d,respectively(37.7±0.4)? significantly less than the control group(8.4±4.4)d,(38.0±0.6)?(t = 2.194,2.179;P<0.05)There was no significant difference between the FIGFI guiding group and the control group in liver function,length of stay and improvement of postoperative complications(P > 0.05).ConclusionFIGFI can guide anatomic right hepatectomy for HCC in real time,which is helpful to improve the accuracy of right hepatectomy for HCC and has a good application prospect.Compared with the traditional anatomic hepatectomy,the anatomic hepatectomy guided by FIGFI can clearly define the scope of hepatectomy,but it has no obvious advantages in intraoperative and postoperative recovery,and can be used as an important auxiliary means of anatomic hepatectomy. |
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