Background: Indocyanine green (ICG) fluorescence has seen extensive application across medical and surgical fields, praised for its real-time navigation capabilities and low toxicity. Initially employed to assess liver function, ICG fluorescence is now integral to liver surgery, aiding in tumor detection, liver segmentation, and the visualization of bile leaks. This study reviews current protocols and ICG fluorescence applications in liver surgery, with a focus on optimizing timing and dosage based on clinical indications. Methods: Following PRISMA guidelines, we systematically reviewed the literature up to 27 January 2024, using PubMed and Medline to identify studies on ICG fluorescence used in liver surgery. A systematic review was performed to evaluate dosage and timing protocols for ICG administration. Results: Of 1093 initial articles, 140 studies, covering a total of 3739 patients, were included. The studies primarily addressed tumor detection (40%), liver segmentation (34.6%), and both (21.4%). The most common ICG fluorescence dose for tumor detection was 0.5 mg/kg, with administration occurring from days to weeks pre-surgery. Various near-infrared (NIR) camera systems were utilized, with the PINPOINT system most frequently cited. Tumor detection rates averaged 87.4%, with a 10.5% false-positive rate. Additional applications include the detection of bile leaks, lymph nodes, and vascular and biliary structures. Conclusions: ICG fluorescence imaging has emerged as a valuable tool in liver surgery, enhancing real-time navigation and improving clinical outcomes. Standardizing protocols could further enhance ICG fluorescence efficacy and reliability, benefitting patient care in hepatic surgeries.
背景：吲哚菁绿（ICG）荧光成像因其实时导航能力与低毒性，已在医学及外科领域获得广泛应用。最初用于肝功能评估的ICG荧光技术，现已成为肝脏手术中不可或缺的工具，在肿瘤检测、肝段划分及胆漏可视化等方面发挥重要作用。本研究系统综述了当前ICG荧光在肝脏手术中的应用方案，重点探讨基于临床适应证的给药时机与剂量优化策略。方法：遵循PRISMA指南，我们系统检索了截至2024年1月27日PubMed和Medline数据库中关于ICG荧光应用于肝脏手术的研究文献，对ICG给药剂量与时机方案进行系统性评价。结果：从1093篇初筛文献中纳入140项研究，共涵盖3739例患者。研究主要涉及肿瘤检测（40%）、肝段划分（34.6%）及两者联合应用（21.4%）。肿瘤检测最常用的ICG剂量为0.5 mg/kg，给药时间从术前数天至数周不等。各研究采用了多种近红外（NIR）摄像系统，其中PINPOINT系统被引用频次最高。肿瘤检测率平均达87.4%，假阳性率为10.5%。其他应用还包括胆漏检测、淋巴结示踪以及血管与胆道结构显影。结论：ICG荧光成像已成为肝脏手术中的重要辅助工具，通过增强实时导航能力显著改善临床疗效。标准化应用方案有望进一步提升ICG荧光技术的效能与可靠性，为肝脏手术患者提供更优质的诊疗服务。
肿瘤(癌症)患者之家