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.
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。