Shi Jia,Cheng Qianqian,Wu Zhixiang,et al.Application of near-infrared Indocyanine Green fluorescence imaging in the Surgery of Childhood Hepatoblastoma[J].Journal of Clinical Pediatric Surgery,2021,20(10):916-920.[doi:10.12260/lcxewkzz.2021.10.004]
吲哚菁绿近红外荧光显像在儿童肝母细胞瘤手术中的应用初探
- Title:
- Application of near-infrared Indocyanine Green fluorescence imaging in the Surgery of Childhood Hepatoblastoma
- 分类号:
- R917.76;R445.9;R735.7;R726.1
- 摘要:
- 目的 吲哚氰绿（Indocyanine green，ICG）能够在肝癌组织中特异性聚集，已作为非特异性荧光探针用于精准肝脏外科手术中肿瘤病灶成像。但其在儿童肝母细胞瘤中的应用尚处于起步阶段。本文拟探讨ICG近红外荧光成像技术在儿童肝母细胞瘤病灶识别、切缘判断中的应用潜力。方法 收集2019年12月至2021年5月在上海交通大学医学院附属新华医院行ICG近红外荧光术中实时导航手术的6例肝母细胞瘤患者临床影像资料（肿瘤大小及位置）和病理数据。所有病例均以0.5 mg/kg的剂量于术前45~72 h静脉注射ICG，并在术中使用ICG近红外荧光成像系统观察肿瘤病灶及手术切缘。结果 6例HB患者中，单发肿瘤病灶5例，多发肿瘤病灶（系术后肝内复发）1例。肿瘤中位直径为7.5 cm（1~10 cm）。肿瘤距离肝脏包膜最近距离为0~15 mm。5例进行了右肝肿瘤解剖性切除术，1例行不规则肝肿瘤切除术。术中可观察到与正常肝组织相比，肝肿瘤显示出绿色荧光。肿瘤切除后，切缘处无荧光显像，与切缘病理检查结果相符合。所有病例均未观察到与ICG注射有关的不良事件。结论 术中ICG近红外荧光成像可用于判断肝母细胞瘤病灶位置，判断肿瘤切缘是否干净，对肿瘤切除手术具有一定的导航作用。ICG注射的合适时机以及对肿瘤病灶检测的敏感性，还有待通过更多病例的经验积累之后进一步研究和阐明。
- Abstract:
- Objective Indocyanine green (ICG) has been used for intraoperative real-time navigation in precise liver surgery as it can specifically accumulate in liver cancer tissues.This article explored the application of near-infrared fluorescence imaging with ICG for identifying intraoperative lesions and defining tumor margins for childhood hepatoblastoma (HB).Methods The clinical data of 6 children with HB undergoing ICG fluorescence-guided surgery from December 2019 to May 2021 was resepectively reviewed.ICG at a 0.5 mg/kg body weight dose was injected intravenously to all patients 45-72 hours before the operation.The ICG near-infrared fluorescence imaging system was applied to observe the tumor lesions and resection margins during the operation. Results Of the 6 patients, 5 were presented with single lesion and 1 with multiple lesions (recurrent after surgery).The median tumor diameter was 7.5cm (1-10 cm) and the distance between the tumor and liver capsule was 0 to 15 mm.5 children underwent radical resection of right liver tumor while 1 underwent irregular liver tumor resection.Fluorescence was dected in all liver lesions, and absent at the surgical margin after the operation, which is consistent with the pathological examination.No adverse events related to ICG injection were observed. Conclusion Real-time ICG fluorescence imaging technique during hepatectomy can help to define the resection margin of HB and scattered metastatic lesions in the liver.Whereas the appropriate timing of ICG injection and imaging limitation on the tumor’s depth and size require to be further studied and clarified.
参考文献/References:
1 Ranganathan S,Lopez-Terrada D,Alaggio R.Hepatoblastoma and Pediatric Hepatocellular Carcinoma:An Update[J].Pediatr Dev Pathol,2020,23(2):79-95.DOI:10.1177/1093526619875228.
2 Meyers R,Hiyama E,Czauderna P,et al.Liver Tumors in Pediatric Patients[J].Surg Oncol Clin N Am,2021,30(2):253-274.DOI:10.1016/j.soc.2020.11.006.
3 袁晓军.儿童肝母细胞瘤多学科诊疗专家共识(CCCG-HB-2016)[J].中华小儿外科杂志,2017,38(10):733-739.DOI:10.3760/cma.j.issn.0253-3006.2017.10.003. Yuan XJ.Expert Consensus for Multidisciplinary Management of Hepatoblastoma(CCCG-HB-2016)[J].Chin J Pediatr Surg,2017,38(10):733-739.DOI:10.3760/cma.j.issn.0253-3006.2017.10.003.
4 陈芝雪,董瑞.肝母细胞瘤多学科治疗方案的研究进展[J].临床小儿外科杂志,2020,19(5):398-403.DOI:10.3969/j.issn.1671-6353.2020.05.005. Chen ZX,Dong R.Advances in the treatment of hepatoblastoma[J].J Clin Ped Sur,2020,19(5):398-403.DOI:10.3969/j.issn.1671-6353.2020.05.005.
5 Handgraaf HJM,Boogerd LSF,H?ppener DJ,et al.Long-term follow-up after near-infrared fluorescence-guided resection of colorectal liver metastases:A retrospective multicenter analysis[J].Eur J Surg Oncol,2017,43(8):1463-1471.DOI:10.1016/j.ejso.2017.04.016.
6 Purich K,Dang JT,Poonja A,et al.Intraoperative fluorescence imaging with indocyanine green in hepatic resection for malignancy:a systematic review and meta-analysis of diagnostic test accuracy studies[J].Surg Endosc,2020,34(7):2891-2903.DOI:10.1007/s00464-020-07543-2.
7 Reinhart MB,Huntington CR,Blair LJ,et al.Indocyanine Green:Historical Context,Current Applications,and Future Considerations[J].Surg Innov,2016,23(2):166-175.DOI:10.1177/1553350615604053.
8 姚伟,董岿然,李凯,等.吲哚菁绿荧光显像技术在肝母细胞瘤精准切除手术中的应用[J].临床小儿外科杂志,2019,18(2):107-111.DOI:10.3969/j.issn.1671-6353.2019.02.008. Yao W,Dong KR,Li K,et al.Application of indocyanine green fluorescence imagine technique in precise hepatectomy for hepatoblastoma[J].J Clin Ped Sur,2019,18(2):107-111.DOI:10.3969/j.issn.1671-6353.2019.02.008.
9 Egloff-Juras C,Bezdetnaya L,Dolivet G,et al.NIR fluorescence-guided tumor surgery:new strategies for the use of indocyanine green[J].Int J Nanomedicine,2019,14:7823-7838.DOI:10.2147/IJN.S207486.
10 Paraboschi I,De Coppi P,Stoyanov D,et al.Fluorescence imaging in pediatric surgery:State-of-the-art and future perspectives[J].J Pediatr Surg,2021,56(4):655-662.DOI:10.1016/j.jpedsurg.2020.08.004.
11 Nakaseko Y,Ishizawa T,Saiura A.Fluorescence-guided surgery for liver tumors[J].J Surg Oncol,2018,118(2):324-331.DOI:10.1002/jso.25128.
12 Ishizawa T,Saiura A,Kokudo N.Clinical application of indocyanine green-fluorescence imaging during hepatectomy[J].Hepatobiliary Surg Nutr,2016,5(4):322-328.DOI:10.21037/hbsn.2015.10.01.
13 Yamada Y,Ohno M,Fujino A,et al.Fluorescence-Guided Surgery for Hepatoblastoma with Indocyanine Green[J].Cancers (Basel),2019,11(8):1215.DOI:10.3390/cancers11081215.
14 方驰华,梁洪玻,迟崇巍,等. 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[J].中华外科杂志,2016,54(6):444-450.DOI:10.3760/cma.j.issn.0529-5815.2016.06.011. Fang CH,Liang HB,Chi CW,et al.Application of indocyanine green-fluorescent imaging technique in planning resection line and real-time surgical navigation in small hepatocellular carcinoma[J].Chin J Surg,2016,54(6):444-450.DOI:10.3760/cma.j.issn.0529-5815.2016.06.011.
15 Yamamichi T,Oue T,Yonekura T,et al.Clinical application of indocyanine green (ICG) fluorescent imaging of hepatoblastoma[J].J Pediatr Surg,2015,50(5):833-836.DOI:10.1016/j.jpedsurg.2015.01.014.
16 Souzaki R,Kawakubo N,Matsuura T,et al.Navigation surgery using indocyanine green fluorescent imaging for hepatoblastoma patients[J].Pediatr Surg Int,2019,35(5):551-557.DOI:10.1007/s00383-019-04458-5.
17 Kitagawa N,Shinkai M,Mochizuki K,et al.Navigation using indocyanine green fluorescence imaging for hepatoblastoma pulmonary metastases surgery[J].Pediatr Surg Int,2015,31(4):407-411.DOI:10.1007/s00383-015-3679-y.
相似文献/References:
[1]彭宇明,尹强,高红强,等.吲哚菁绿荧光染色引导下解剖性右半肝切除治疗儿童肝脏肿瘤[J].临床小儿外科杂志,2018,17(08):597.
Peng Yumin,Yin Qiang,Gao Hongqiang,et al.Anatomic righthalf of indocyanine green fluorescent staining hepatectomy for children with liver tumors.[J].Journal of Clinical Pediatric Surgery,2018,17(10):597.
[2]姚伟,董岿然,李凯,等.吲哚菁绿荧光显像技术在肝母细胞瘤精准切除手术中的应用[J].临床小儿外科杂志,2019,18(02):107.
Yao W,Dong KR,Li K,et al.Application of indocyanine green fluorescence imagine technique in precise hepatectomy for hepatoblastoma.[J].Journal of Clinical Pediatric Surgery,2019,18(10):107.
[3]尹强.吲哚菁绿荧光成像技术在小儿外科领域的应用与局限[J].临床小儿外科杂志,2021,20(10):901.[doi:10.12260/lcxewkzz.2021.10.001]
Yin Qiang.Application and prospect of indocyanine green fluorescence imaging in pediatric surgery[J].Journal of Clinical Pediatric Surgery,2021,20(10):901.[doi:10.12260/lcxewkzz.2021.10.001]
[4]姚伟,董岿然.荧光引导技术在儿童肿瘤手术中的应用及展望[J].临床小儿外科杂志,2021,20(10):906.[doi:10.12260/lcxewkzz.2021.10.002]
Yao Wei,Dong Kuiran.Applications and future prospects of fluorescence guided surgery for pediatric oncology[J].Journal of Clinical Pediatric Surgery,2021,20(10):906.[doi:10.12260/lcxewkzz.2021.10.002]
[5]季春宜,尹强,袁妙贤,等.吲哚菁绿荧光成像技术在腹腔镜下肠隔膜手术中的应用研究[J].临床小儿外科杂志,2021,20(10):911.[doi:10.12260/lcxewkzz.2021.10.003]
Ji Chunyi,Yin Qiang,Yuan Miaoxian,et al.Application of indocyanine green fluorescent imaging for laparoscopy of intestinal diaphragm[J].Journal of Clinical Pediatric Surgery,2021,20(10):911.[doi:10.12260/lcxewkzz.2021.10.003]
[6]马立飞,周辉霞,周晓光,等.吲哚菁绿荧光实时显影技术在儿童复杂肾积水机器人辅助腹腔镜手术中的初步应用[J].临床小儿外科杂志,2021,20(10):921.[doi:10.12260/lcxewkzz.2021.10.005]
Ma Lifei,Zhou Huixia,Zhou Xiaoguang,et al.Applications of indocyanine green and near-infrared fluorescence during complex robot-assisted laparoscopic pyeloplasty[J].Journal of Clinical Pediatric Surgery,2021,20(10):921.[doi:10.12260/lcxewkzz.2021.10.005]
[7]潘力迦,吴晔明,王奕,等.利用近红外-吲哚菁绿成像系统判断急性肠缺血模型缺血肠段的实验研究[J].临床小儿外科杂志,2021,20(10):925.[doi:10.12260/lcxewkzz.2021.10.006]
Pan Lijia,Wu Yeming,Wang Yi,et al.Application of near infrared-indocyanine green imaging system for judging ischemic intestinal segment in a canine model of acute intestinal ischemia[J].Journal of Clinical Pediatric Surgery,2021,20(10):925.[doi:10.12260/lcxewkzz.2021.10.006]
[8]徐琛,汤悦,郑珊,等.Kasai术中肝脏吲哚菁绿显像特点与胆道闭锁患儿早期预后的关系探索[J].临床小儿外科杂志,2022,21(08):738.[doi:10.3760/cma.j.cn101785-202111058-007]
Xu Chen,Tang Yue,Zheng shan,et al.Study of real-time imaging with indocyanine green during hepatoportoenterostomy as a prognostic factor in children with biliary atresia[J].Journal of Clinical Pediatric Surgery,2022,21(10):738.[doi:10.3760/cma.j.cn101785-202111058-007]
备注/Memo
收稿日期:2021-04-27。
基金项目:国家自然科学基金（编号：81874234）；苏州市临床医学专家团队引进项目（编号：SZYJTD201706）；上海市市级医院新兴前沿技术联合攻关项目（编号：SHDC12018123）；上海市生物医药领域科技支撑项目（编号：18401931800）；上海市转化医学协同创新中心项目（编号：TM201809）
通讯作者:吕凡,Email:lvfan@xinhuamed.com.cn