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中华胸部外科电子杂志

中华胸部外科电子杂志 ›› 2019, Vol. 06 ›› Issue (04) : 234 -238. doi: 10.3877/cma.j.issn.2095-8773.2019.04.06

所属专题： 文献；

论著

吲哚菁绿荧光成像在胸腔镜食管癌手术中的应用
郭金成1,†(), 卢家彬1, 乔呈瑞1, 杨世卿1   
  1. 1. 454001　焦作市第二人民医院（河南理工大学第一附属医院）胸外科
  • 收稿日期:2019-09-20 出版日期:2019-11-28
  • 通信作者: 郭金成

Application of indocyanine green fluorescence imaging in video-assisted thoracoscopic surgery for esophageal carcinoma

Jincheng Guo1,†(), Jiabin Lu1, Chengrui Qiao1, Shiqing Yang1   

  1. 1. Department of Thoracic Surgery, The First Affiliated Hospital of Henan Polytechnic University, Jiaozuo 454001, China
  • Received:2019-09-20 Published:2019-11-28
  • Corresponding author: Jincheng Guo
  • About author:
    Corresponding author: Guo Jincheng, Email:
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郭金成, 卢家彬, 乔呈瑞, 杨世卿. 吲哚菁绿荧光成像在胸腔镜食管癌手术中的应用[J]. 中华胸部外科电子杂志, 2019, 06(04): 234-238.

Jincheng Guo, Jiabin Lu, Chengrui Qiao, Shiqing Yang. Application of indocyanine green fluorescence imaging in video-assisted thoracoscopic surgery for esophageal carcinoma[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2019, 06(04): 234-238.

目的

评价吲哚菁绿(ICG)荧光成像在胸腔镜食管癌手术中应用的价值。

方法

随机选取32例食管癌患者作为实验组，在胸腔镜手术中利用ICG荧光成像技术，判断管状胃血液灌注情况，选择灌注良好的区域完成吻合。术后根据临床症状和影像学来判定吻合口漏是否发生，并记录吻合口瘘发生情况。同期选取38例常规手术组食管癌患者作为对照组。

结果

全组未出现由于注射ICG而引起的死亡等不良反应。所有患者采用经纵隔途径食管胃颈部吻合方式。器械吻合52例(实验组24例，对照组28例)；手工吻合18例(实验组8例，对照组10例)，两组患者的吻合方式无统计学差异(P>0.05)。临床症状和影像学证实的吻合口漏共7例，其中实验组2例(6.25%)，显著低于同期不用此项技术的对照组5例(13.15%)。

结论

ICG荧光素成像是一种安全可行的技术，术中通过一个可视化的效果，评估管状胃的血流灌注情况，有助于降低食管癌手术后吻合口瘘的发生。

关键词: 吲哚青绿, 荧光成像, 胸腔镜手术, 食管癌
Objective

To study the clinical use of indocyanine green(ICG) fluorescence imaging in video-assisted thoracoscopic surgery (VATS) for the treatment of esophageal carcinoma.

Methods

32 cases with esophageal cancer were randomly selected as the experimental group. ICG fluorescence imaging technique was applied in this group to evaluate the blood perfusion of tubular stomach during thoracoscopic surgery, and to determine the well-perfused area for anastomosis. Clinical symptoms and imaging were used to diagnosis anastomotic leakage after esophagectomy. Another 38 patients with esophageal cancer with routine surgery were randomly selected as the control group.

Results

There were no deaths or other adverse reactions caused by indocyanine green ICG injection. The cervical esophagogastrostomy through the esophageal bed was performed in all patients, with stapled anastomoses in 52 cases (experimental group 24, control group28), and manual anastomosis in 18 cases (experimental group 8, control group 10). There was no statistical difference in the methods of anastomosis between the two groups(P>0.05). Clinical symptoms and imaging confirmed 7 cases of anastomotic leakage, with 2 cases in experimental group (6.25%) and 5 cases in the control group(13.15%). The incidence of anastomotic leakage in the experiment group was significantly lower than that in the control group.

Conclusions

ICG fluorescence imaging is a safe and effective technology to evaluate blood perfusion of tubular stomach in a visualized way during surgery and to reduce anastomotic leakage after esophagectomy.

Key words: Indocyanine green, Fluorescence imaging, Video-assisted thoracoscopic surgery, Esophageal carcinoma
图1 ICG荧光图像显示灌注区域胃壁内的血管网络
图2 贲门部及部分胃小弯侧、管胃顶端荧光图像缺失
图3 亚甲蓝标记灌注区域与非灌注区域界限
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