文章：

肝胆胰手术中考虑血管重建的吲哚菁绿荧光实时血流评估

Real-Time Blood Flow Assessment Using ICG Fluorescence Imaging During Hepatobiliary and Pancreatic Surgery with Consideration of Vascular Reconstruction

原文发布日期：3 March 2025

DOI: 10.3390/cancers17050868

类型: Article

开放获取: 是

英文摘要：

Background/Objectives: Indocyanine green (ICG) fluorescence imaging is widely utilized for visualizing hepatic tumors, hepatic segmentation, and biliary anatomy, improving the safety and curability of cancer surgery. However, its application for perfusion assessment in hepatobiliary and pancreatic (HBP) surgery has been less explored. Methods: This study evaluated outcomes of patients undergoing HBP surgery with vascular reconstruction from April 2022 to August 2024. During surgery, ICG (1.25–5 mg/body) was administered intravenously to assess the need and quality of vascular reconstruction via fluorescence imaging. Results: Among 30 patients undergoing hepatectomies and/or pancreatectomies, ICG fluorescence imaging was used in 16 cases (53%) to evaluate organ and vascular perfusion. In two hepatectomy cases with consideration of reconstruction of the middle hepatic veins, sufficient fluorescence intensities in drainage areas led to the avoidance of middle hepatic vein reconstruction. In 14 cases requiring vascular reconstruction, fluorescence imaging visualized smooth blood flow through anastomotic sites in 11 cases, while insufficient signals were observed in 3 cases. Despite this, re-do anastomoses were not indicated because the fluorescence signals in the targeted organs were adequate. Postoperative contrast-enhanced computed tomography confirmed satisfactory blood perfusion in all cases. Conclusions: Real-time blood flow assessment using ICG fluorescence imaging provides valuable information for intraoperative decision-making in HBP surgeries that require vascular reconstruction of major vessels, such as hepatic arteries, veins, and the portal system.

摘要翻译： 

背景/目的：吲哚菁绿（ICG）荧光成像技术已广泛应用于肝脏肿瘤可视化、肝段划分及胆道解剖定位，有效提升了肿瘤手术的安全性与根治性。然而，该技术在肝胆胰（HBP）手术中用于灌注评估的研究尚不充分。方法：本研究评估了2022年4月至2024年8月期间接受血管重建的HBP手术患者。术中通过静脉注射ICG（1.25–5 mg/体）并利用荧光成像技术评估血管重建的必要性及质量。结果：在30例接受肝切除和/或胰腺切除的患者中，16例（53%）采用ICG荧光成像评估器官及血管灌注。其中2例考虑重建肝中静脉的肝切除病例，因引流区域荧光强度充足而避免了肝中静脉重建。在14例需行血管重建的病例中，11例通过荧光成像观察到吻合口血流顺畅，3例出现信号不足现象。尽管如此，由于目标器官荧光信号充足，均未进行二次吻合。术后增强计算机断层扫描证实所有病例血流灌注均达到满意效果。结论：ICG荧光成像的实时血流评估技术，为需要重建肝动脉、肝静脉及门静脉系统等主要血管的HBP手术，提供了重要的术中决策依据。

原文链接：

Real-Time Blood Flow Assessment Using ICG Fluorescence Imaging During Hepatobiliary and Pancreatic Surgery with Consideration of Vascular Reconstruction