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中华胸部外科电子杂志

中华胸部外科电子杂志 ›› 2018, Vol. 05 ›› Issue (02) : 124 -128. doi: 10.3877/cma.j.issn.2095-8773.2018.02.11

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综述

吲哚箐绿荧光示踪在胃肠食管外科手术中的应用进展
姜皓耀1, 李志刚1,†()   
  1. 1. 200030　上海交通大学附属胸科医院胸外科　上海交通大学食管疾病诊治中心
  • 收稿日期:2018-02-20 出版日期:2018-05-28
  • 通信作者: 李志刚

Progress of application of indocyanine green fluorescent tracer in gastro-esophageal surgery

Haoyao Jiang1, Zhigang Li1,†()   

  1. 1. Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
  • Received:2018-02-20 Published:2018-05-28
  • Corresponding author: Zhigang Li
  • About author:
    Corresponding author: Li Zhigang, Email:
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姜皓耀, 李志刚. 吲哚箐绿荧光示踪在胃肠食管外科手术中的应用进展[J]. 中华胸部外科电子杂志, 2018, 05(02): 124-128.

Haoyao Jiang, Zhigang Li. Progress of application of indocyanine green fluorescent tracer in gastro-esophageal surgery[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2018, 05(02): 124-128.

近红外荧光成像技术的发展，使得其在各种外科手术中发挥出重要作用。吲哚箐绿(ICG)是一种新型示踪剂，术中可近红外荧光成像。使用ICG做荧光剂，可以无创探测淋巴脉管系统，从而进行术中功能的诊断和评估。该文探讨了ICG荧光示踪在胃肠食管外科中的应用，主要包括术中前哨淋巴结(SLN)活检，以及重建手术中血管造影对循环血流状况的评估。由于ICG荧光示踪仍在萌芽阶段，因此仍需更多的研究来评估其潜在的应用价值。

关键词: 吲哚箐绿, 近红外荧光成像, 胃肠食管手术, 前哨淋巴结, 血管造影

Technical developments in near-infrared fluorescence (NIRF) imaging have made it play a critical role in various fields of surgery. Indocyanine green (ICG) is a new type of fluorochrome that can stain tissues under the near-infrared fluorescence during surgery. Non-invasive imaging of the lymphatic vasculature for intraoperative diagnosis and assessment of function has been uniquely accomplished with NIR using indocyanine green (ICG). In this review, we mainly discuss the application of ICG fluorescent tracer in gastro-esophageal surgery. There are two main fields where ICG fluorescent tracer can be applied: intraoperative sentinel lymph node mapping and biopsy; video-angiography assessing vascular circulation in reconstructive surgery. Because ICG is still in its nascent stages, more studies need to be carried out to fully evaluate its potential.

Key words: Indocyanine green, Near-infrared fluorescence, Gastro-esophageal surgery, Sentinel lymph node, Angiography
表1 ICG荧光示踪在胃肠手术中应用情况
作者(出版时间) 样本量 肿瘤类型 手术方式 ICG剂量 注射部位 显影SLN病例数[(n/N(%)] 平均SLN个数 假阴性[(n/N(%)]
Hiratsuka等[7](2001) 74 胃癌 开放 5 ml 环周浆膜下 73/74 (98.6) 2.6 1/10(10.0)
Tajima等[8](2009) 56 胃癌 未知 2 ml 术前黏膜下、术中浆膜下 54/56(96.4) 7.2 6/17 (35.3)
Miyashiro等[9](2011) 10 胃癌 腹腔镜 2～4 ml 环周黏膜下 10/10(100.0) 3.1 未知
Hironori等[10](2017) 6 胃癌 腹腔镜 0.5 ml 环周黏膜下 6/6(100.0) 7 未知
Tummers[11](2016) 22 胃癌 开放 1.6 ml 环周浆膜下 21/22 (95.5) 3.1 未知
Kusano等[12](2008) 48 胃癌22例；结肠癌26例 腹腔镜、开放 2 ml 环周浆膜下 20/22(90.9)；23/26(88.5) 3.6；2.6 6/10(60.0)；4/6(66.7)
Noura等[13](2009) 25 结肠癌 腹腔镜 1 ml 未知 23/25 (92.0) 2.1 未知
Chand等[14](2017) 10 结肠癌 腹腔镜 1 ml 环周浆膜下 8/10(80.0) 未知 未知
Hachey等[15](2016) 9 食管癌 胸腔镜 1 ml 环周黏膜下 6/9(66.7) 3 未知
表2 胃肠消化道肿瘤手术中应用ICG荧光血供造影
作者(出版时间) 样本量 类型 ICG剂量(mg) 给药途径 成功显影(%) 改变术式 瘘[n(%)] 改变术式瘘[n(%)]
Frederic等(2014) 30 结肠 25 静脉 96.7 3 0 0(0)
Mehraneh等[20](2015) 139 结肠 3.75～ 7.5 静脉 99 11 2(1.4) 0(0)
Rino等[21](2014) 33 食管 2.5 静脉 100 0 5(15.2) 0(0)
Koyanagi等[22](2016) 40 食管 1.25或2.5 中心静脉 100 0 7(17.5) 0(0)
Kubota等[23](2013) 5 食管 5 静脉 100 0 0(0) 0(0)
Ohi等[24](2017) 59 食管 2.5 静脉 100 未做荧光61例 1(1.7) 9 (14.7)
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