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):911-915.[doi:10.12260/lcxewkzz.2021.10.003]
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
- Title:
- Application of indocyanine green fluorescent imaging for laparoscopy of intestinal diaphragm
- Keywords:
- Fluorescent Dyes; Indocyanine Green; Diagnostic Imaging; Laparoscopy; Intestinal Diaphragm; Child
- 分类号:
- R917.76;R726.556;R726.1;R445.9
- 摘要:
- 目的 探讨吲哚菁绿（indocyanine green，ICG）分子荧光成像技术在先天消化道畸形肠隔膜手术中的应用价值。方法 以2018年5月至2020年12月湖南省儿童医院普外一科10例肠隔膜患者作为研究对象，所有患者在ICG分子荧光成像技术指导下完成手术。术中按0.5 mg/kg剂量、将2.5 mg/20 mL ICG稀释液经胃管注入，通过ICG分子荧光成像技术对肠隔膜进行实时定位引导；术中完成吻合后再对吻合口部进行ICG分子荧光检测，协助判断有无渗漏。结果 10例患者均在ICG分子荧光成像技术辅助下，术中实时呈现肠隔膜的精准定位，且发现肠吻合口渗漏1例，予以及时修补后再次检测原肠吻合口渗漏处无荧光聚集；术后无一例肠漏发生。结论 ICG分子荧光成像技术不仅可在术中实时精准定位肠隔膜，而且发现吻合口渗漏的敏感度高。ICG分子荧光成像技术在儿童先天消化道畸形的手术导航中具有一定的临床应用价值。
- Abstract:
- Objective To explore the value of application of precise surgical navigation of indocyanine green (ICG) fluorescent imaging for improving the safety and effectiveness of surgery for congenital gastrointestinal malformation of intestinal diaphragm.Methods From May 2018 to December 2020, ICG molecular fluorescent imaging was applied for 10 patients with intestinal diaphragm disease.Intraoperative transgastric tube dosing was adpoted.After injecting ICG into a gastric tube with 2.5 mg/20 mL ICG diluent at a dose of 0.5 mg/kg, ICG molecular fluorescent imaging was performed for real-time positioning and guidance of intestinal diaphragm.Upon a completion of anastomosis, ICG molecular fluorescent detection was performed on the anastomosis for assisting in detecting possible leakages.Results With an aid of ICG molecular fluorescent imaging, intestinal diaphragms were precisely positioned during real-time operations.One intestinal anastomotic leakage was detected during operation.After repairing in time, original intestinal anastomotic leakage was plugged without fluorescent accumulation and no intestinal leakage occurred postoperatively.Conclusion ICG molecular fluorescent imaging may locate intestinal diaphragm in a real-time operation and detect anastomotic leakage with a high sensitivity.This technology has a certain practical value of surgical navigation for children with congenital gastrointestinal malformations as it enhances the safety and effectiveness of operations.
参考文献/References:
1 Nguyen DP,Huber PM,Metzger TA,et al.A specific mapping study using fluorescence sentinel lymph node detection in patients with intermediate and high-risk prostate cancer undergoing extended pelvic lymph node dissection[J].Eur Urol,2016,70(5):734-737.DOI:10.1016/j.eururo.2016.01.034.
2 Alford R,Simpson HM,Duberman J,et al.Toxicity of fluorophores used in molecular Imaging:literature reriew[J].Mol imaging,2009,8(6):341-354.DOI:10.2310/7290.2009.00031.
3 Vahrmeijer AL,Hutteman M,van der Vorst JR,et al.Image-guided cancer surgery using near-infrared fluorescence[J].Nat Rev Clin Oncol,2013,10(9):507-518.DOI:10.1038/nrclinonc.2013.123.
4 Adams SD,Stanton MP.Malrotation and intestinal atresias[J].Early Hum,2014,90(12):921-925.DOI:10.1016/j.earlhumdev.2014.09.017.
5 梁娟,王艳萍,缪蕾.等.中国围产儿先天性小肠闭锁或狭窄流行病学调查[J].中国妇幼保健,2000,15:252-253.DOI:10.3969/j.issn.1001-4411.2000.04.026. Liang J,Wang YP,Miu L,et al.Epidemiological survey of congenital small bowel atresia or stenosis in perinatal infants in China[J].Maternal and Child Health Care of China,2000,15:252-253.DOI:10.3969/j.issn.1001-4411.2000.04.026.
6 Ishizawa T,Fukushima N,Shibahara J,et al.Real-time identification of liver cancers by using indocyanine green fluorescent imaging[J].Cancer,2009,115(11):2491-2504.DOI:10.1002/cncr.24291.
7 Faybik P,Krenn CG,Baker A,et al.Comparison of invasive and noninvasive measurement of plasma disappearance rate of indocyanine green in patients undergoing liver transplan-tation:a prospective nvestigator-blinded study[J].Liver Transpl,2004,10(8):1060-1064.DOI:10.1002/lt.20205.
8 Rubens FD,Ruel M,Fremes SE.A new and simplified method for coronary and graft imaging during CABG[J].Heart Surg Forum,2002,5(2):141-144.DOI:10.1002/hed.1156.
9 Ogata F,Narushima M,Mihara M,et al.Intraoperative lymphography using indocyanine green dye for near-infraredfluorescence labeling in lymphedema[J].Ann Plast Surg,2007,59(2):180-184.DOI:10.1097/01.sap.0000253341.70866.54.
10 Inoue T,Nisbi T,Nakano Y,et al.Axillary lymph node recurrence after sentinel lymph node biopsy performed using a combination of indocyanine green fluorescence and the blue dye method in early breast cancer[J].Breast Cancer,2016,23(2):295-300.DOI:10.1007/s12282-014-0573-8.
11 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 fluorescent imaging technique during precise hepatectomy for hepatoblastoma[J].J Clin Ped Sur,2019,18(2):107-111.DOI:10.3969/j.issn.1671-6353.2019.02.008.
12 Rentea RM,Halleran DR,Ahmad H,et al.Preliminary use of indocyanine green fluorescence angiography and value in predicting the vascular supply of tissues needed to perform cloacal,anorectal malformation and Hirschsprung reconstructions[J].Eur J Pediatr Surg,2020,30(6):505-511.DOI:10.1055/s-0039-1700548.
13 徐晓钢,曾纪晓,刘斐,等.吲哚菁绿荧光血管显像技术在单孔腹腔镜巨结肠根治术中的应用[J].中国微创外科杂志,2021,21(2):165-168.DOI:10.3969/j.issn.1009-6604.2021.02.015. Xu XG,Zeng JX,Liu F,et al.Application of indocyanine green fluorescent angiography during single-port laparoscopic radical operation for Hirschsprung’s disease[J].Chin J Min Inv Surg,2021,21(2):165-168.DOI:10.3969/j.issn.1009-6604.2021.02.015.
14 袁妙贤,尹强,季春宜,等.三维CT重建联合ICG荧光染色技术在腹腔镜先天性胆管扩张症根治术中的应用[J].临床小儿外科杂志,2020,19(7):614-618.DOI:10.3969/j.issn.1671-6353.2020.07.010. Yuan MX,Yin Q,Ji CY,et al.Application of three-dimensional computed tomography reconstruction plus indocyanine green fluorescent staining technique during radical laparoscopy for congenital biliary dilatation[J].J Clin Ped Sur,2020,19(7):614-618.DOI:10.3969/j.issn.1671-6353.2020.07.010.
15 Guillén G,López-Fernández S,Molino JA,et al.Pilot experience with indocyanine green navigation in pediatric surgery[J].Cir Pediatr,2019,32(3):121-127.
16 Fernández-Bautista B,Mata DP,Parente A,et al.First Experience with Fluorescence in Pediatric Laparoscopy[J].European J Pediatr Surg Rep,2019,7(1):e43-e46.DOI:10.1055/s-0039-1692191.
17 中华医学会数字医学分会,中国研究型医院学会数字智能化专业委员会,中国医师协会肝癌专业委员会,中国医师协会临床精准医学专业委员会,中国图学学会医学图像与设备专业委员会,中国生物物理学会分子影像学专业委员会.计算机辅助联合吲哚菁绿分子荧光影像技术在肝脏肿瘤诊断和手术导航中的应用指南(2019版)[J].南方医科大学学报,2019,39(10):1127-1140.DOI:10.12122/j.issn.1673-4254.2019.10.01. Digital Medicine Branch of Chinese Medical Association,Digital Intelligence Professional Committee of Chinese Research Hospital Association,Liver Cancer Professional Committee of Chinese Medical Doctor Association,et al.Guidelines for Application of Computer-assisted Indocyanine Green Molecular Fluorescent Imaging in Diagnosis and Surgical Navigation of Liver Tumors (2019)[J].Journal of Southern Medical University,2019,39(10):1127-1140.DOI:10.12122/j.issn.1673-4254.2019.10.01.
18 刘青,刘开江.前哨淋巴结检测技术在早期宫颈癌中的应用[J].中国癌症防治杂志,2019,11(3):194-198.DOI:10.3969/j.issn.1674-5671.2019.03.02. Liu Q,Liu KJ.Application of sentinel lymph node detection technology for early cervical cancer[J].Chinese Journal of Cancer Prevention and Treatment,2019,11(3):194-198.DOI:10.3969/j.issn.1674-5671.2019.03.02.
19 Hitier M,Cracowski JL,Hamou C,et al.Indocyanine green fluorescence for free flap monitoring:A pilot study[J].J Craniomaxillofac Surg,2016,44(11):1833-1841.DOI:10.1016/j.jcms.2016.09.001.
20 Koh FH,Tan KK.Fluorescent angiography used to evaluate the perfusion status of anastomosis in laparoscopic anterior resection[J].Ann Surg Oncol,2016,23(Suppl 5):692.DOI:10.1245/s10434-016-5581-9.
21 Carus T,Dammer R.Laparoscopic fluorescence angiography with indocyanine green to control the perfusion of gastrointestinal anastomoses intraoperatively[J].Surg Technol Int,2012,22:27-32.DOI:10.1007/978-3-642-00625-8_120.
22 Jafari MD,Lee KH,Halabi WJ,et al.The use of indocyanine green fluorescence to assess anastomotic perfusion during robotic assisted laparoscopic rectal surgery[J].Surg Endosc,2013,27(8):3003-3008.DOI:10.1007/s00464-013-2832-8.
23 苏昊,包满都拉,王鹏,等.吲哚菁绿荧光融合影像技术在完全腹腔镜右半结肠癌根治术中的应用[J].中华肿瘤杂志,2019,41(9):654-658.DOI:10.3760/cma.j.issn.0253-3766.2019.09.003. Su H,Bao MDL,Wang P,et al.Application of indocyanine green fluorescent fusion imaging technology for complete laparoscopic radical resection of right colon cancer[J].Chinese Journal of Oncology,2019,41(9):654-658.DOI:10.3760/cma.j.issn.0253-3766.2019.09.003.
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备注/Memo
收稿日期:2021-04-19。
基金项目:湖南省卫健委重点专科建设技术创新项目（编号：湘卫医政医管处函[2018]187号）
通讯作者:尹强,Email:qiangyin@hotmail.com