Application Of ICG Fluorescence Imaging In Laparoscopic Hepatectomy For Primary Liver Cancer

Objective:To study the application value of indocyanine green(ICG)molecular fluorescence imaging in laparoscopic hepatectomy for primary liver cancer.Methods:The clinical and pathological data of 112 patients with primary liver cancer who underwent laparoscopic hepatectomy in the Department of Hepatobiliary surgery of the first affiliated Hospital of Bengbu Medical College from December2018 to September 2020 were analyzed retrospectively.56 patients with indocyanine green fluorescence staining during operation were taken as navigation group,62patients who underwent routine laparoscopic hepatectomy were taken as traditional group,and indocyanine green was injected at different time before operation according to the liver function of patients in navigation group.The imaging of indocyanine green in liver during operation,the success and failure of staining,the presence of new lesions during operation and the characteristics of tumor development were observed.The preoperative data and operation-related indexes of the navigation group and the traditional group were compared and analyzed by t-test or?~2test.Results:(1)All patients successfully completed hepatectomy under ICG fluorescence laparoscopy without conversion to laparotomy.New suspicious lesions were found in9 patients under fluorescence imaging,including 4 cases of hepatocellular carcinoma,1 case of inflammatory change and 4 cases of sclerotic nodules.Among the 9 cases,8cases were complicated with liver cirrhosis.During the operation,staining failed in 10patients due to severe liver cirrhosis or the presence of communicating branches.Only8 patients who were injected with ICG before operation failed,and 2 patients who received anti-staining during operation failed.The patients of Child-Pugh grade A could get a good development effect 2 or 3 days before operation,while the patients of grade B had the best tumor development under fluorescence 5 days before operation;all patients had no serious complications and recovered well.(2)Compared with the traditional group,the navigation group had shorter operation time[(227.23?46.59)min vs(245.48?39.82)min,P<0.05],less intraoperative blood loss[(313.04?58.31)ml vs(335.16?50.30)ml,P<0.05],and shorter postoperative hospital stay[(6.82?2.22)d vs(8.10?3.03)d,P<0.05].Conclusion:The development of fluorescence imaging technology provides surgeons with a simple and effective navigation method,which is safe and feasible compared with conventional laparoscopic surgery,which can reduce intraoperative bleeding and shorten operation time;at the same time,it can accurately locate the tumor location and resection boundary to help find superficial small lesions,but how to define the degree of liver cirrhosis and injection time still need to be discussed.