Abstract：
BACKGROUND: Laparoscopic anatomical hepatectomy guided by near-infrared fluorescence imaging (NIR-FI) has been utilized extensively. However, it is difficult to resect \"cone units\" above the third branch of the Glissonean pedicle in the right posterior lobe using the laparoscopic positive or negative staining techniques. Therefore, we undertook a new laparoscopic segmentectomy based on the concept of \"cone unit\" assisted by interventional radiology combined with NIR-FI.
METHODS: Laparoscopic segmentectomy guided by NIR-FI via super-selective hepatic arteriography and trans-arterial injection of ICG was carried out on 13 patients with early-stage HCC between September 2020 and January 2022.11 of cases were successful, and relevant pathological characteristics and perioperative outcomes were retrospectively analyzed.
RESULTS: Two cases failed NIR-FI out of which one case involved over-staining to the non-target segment, and in the other case, which was to undergo laparoscopic segment V resection, only the ventral segment was stained while the imaging of the dorsal segment failed. In the intraoperative conditions, the tumor safe margin was 1.1 (0.7-1.55) cm, the interventional operation time was 50 (45.5-60.5) minutes, the operation time was 280 (242.5-307.5) minutes, the blood loss was 100 (50-200) ml, the postoperative hospital stay was 5 (4.5-5.5) days. No cases converted to laparotomy, and no serious postoperative complications developed.
CONCLUSIONS: NIR-FI through super-selective hepatic arteriography and trans-arterial injection of ICG can provide a clear and lasting navigation aid for laparoscopic segmentectomy, which may have positive implication for early-stage HCC with poor preoperative liver reserves.
METHODS: Laparoscopic segmentectomy guided by NIR-FI via super-selective hepatic arteriography and trans-arterial injection of ICG was carried out on 13 patients with early-stage HCC between September 2020 and January 2022.11 of cases were successful, and relevant pathological characteristics and perioperative outcomes were retrospectively analyzed.
RESULTS: Two cases failed NIR-FI out of which one case involved over-staining to the non-target segment, and in the other case, which was to undergo laparoscopic segment V resection, only the ventral segment was stained while the imaging of the dorsal segment failed. In the intraoperative conditions, the tumor safe margin was 1.1 (0.7-1.55) cm, the interventional operation time was 50 (45.5-60.5) minutes, the operation time was 280 (242.5-307.5) minutes, the blood loss was 100 (50-200) ml, the postoperative hospital stay was 5 (4.5-5.5) days. No cases converted to laparotomy, and no serious postoperative complications developed.
CONCLUSIONS: NIR-FI through super-selective hepatic arteriography and trans-arterial injection of ICG can provide a clear and lasting navigation aid for laparoscopic segmentectomy, which may have positive implication for early-stage HCC with poor preoperative liver reserves.
摘要：
背景：由近红外荧光成像（NIR-FI）引导的腹腔镜解剖性肝切除术已被广泛使用。然而,使用腹腔镜阳性或阴性染色技术很难切除右后叶的Glissonean椎弓根第三分支上方的“锥形单元”。因此,我们在介入放射学结合NIR-FI的辅助下，基于“锥形单元”的概念进行了新的腹腔镜节段切除术。
方法：在2020年9月至2022.11年1月期间，对13例早期HCC患者进行了腹腔镜下NIR-FI引导下通过超选择性肝动脉造影和经动脉注射ICG的节段切除术。并对相关病理特征及围手术期转归进行回顾性分析。
结果：2例NIR-FI失败，其中1例涉及非目标节段过度染色，在另一种情况下，接受腹腔镜V段切除术，只有腹侧节段被染色，而背侧节段的成像失败。在术中条件下，肿瘤安全切缘1.1(0.7-1.55)cm,介入手术时间为50（45.5-60.5）分钟，手术时间为280（242.5-307.5）分钟，失血量为100（50-200）ml，术后住院时间为5天(4.5~5.5天).没有病例转换为剖腹手术，术后无严重并发症发生。
结论：NIR-FI通过超选择性肝动脉造影和经动脉注射ICG可以为腹腔镜肺段切除术提供清晰和持久的导航帮助，这可能对术前肝脏储备较差的早期HCC有积极的意义。
方法：在2020年9月至2022.11年1月期间，对13例早期HCC患者进行了腹腔镜下NIR-FI引导下通过超选择性肝动脉造影和经动脉注射ICG的节段切除术。并对相关病理特征及围手术期转归进行回顾性分析。
结果：2例NIR-FI失败，其中1例涉及非目标节段过度染色，在另一种情况下，接受腹腔镜V段切除术，只有腹侧节段被染色，而背侧节段的成像失败。在术中条件下，肿瘤安全切缘1.1(0.7-1.55)cm,介入手术时间为50（45.5-60.5）分钟，手术时间为280（242.5-307.5）分钟，失血量为100（50-200）ml，术后住院时间为5天(4.5~5.5天).没有病例转换为剖腹手术，术后无严重并发症发生。
结论：NIR-FI通过超选择性肝动脉造影和经动脉注射ICG可以为腹腔镜肺段切除术提供清晰和持久的导航帮助，这可能对术前肝脏储备较差的早期HCC有积极的意义。
