Abstract：
The breadth of pediatric surgical practice and variety of anatomic anomalies that characterize surgical disease in children and neonates require a unique level of operative mastery and versatility. Intraoperative navigation of small, complex, and often abnormal anatomy presents a particular challenge for pediatric surgeons. Clinical experience with fluorescent tissue dye, specifically indocyanine green (ICG), is quickly gaining widespread incorporation into adult surgical practice as a safe, non-toxic means of accurately visualizing tissue perfusion, lymphatic flow, and biliary anatomy to enhance operative speed, safety, and patient outcomes. Experience in pediatric surgery, however, remains limited. ICG-fluorescence guided surgery is poised to address the challenges of pediatric and neonatal operations for a growing breadth of surgical pathology. Fluorescent angiography has permitted intraoperative visualization of colorectal flap perfusion for complex pelvic reconstruction and anastomotic perfusion after esophageal atresia repair, while its hepatic absorption and biliary excretion has made it an excellent agent for delineating the dissection plane in the Kasai portoenterostomy and identifying both primary and metastatic hepatoblastoma lesions. Subcutaneous and intra-lymphatic ICG injection can identify iatrogenic chylous leaks and improved yields in sentinel lymph node biopsies. ICG-guided surgery holds promise for more widespread use in pediatric surgical conditions, and continued evaluation of efficacy will be necessary to better inform clinical practice and identify where to focus and develop this technical resource.
摘要：
儿科外科实践的广度和表征儿童和新生儿外科疾病的各种解剖异常需要独特的手术掌握和多功能性水平。术中导航小,复杂，而且通常异常的解剖结构对儿科外科医生提出了特殊的挑战。使用荧光组织染料的临床经验，特别是吲哚菁绿（ICG），作为一种安全的方法，正在迅速广泛地纳入成人外科手术中，准确可视化组织灌注的无毒手段，淋巴流动，和胆道解剖以提高手术速度，安全,和患者结果。儿科手术的经验，然而,仍然有限。ICG-荧光引导手术已准备好应对儿科和新生儿手术的挑战，以应对越来越广泛的手术病理学。荧光血管造影允许术中可视化结肠直肠皮瓣灌注，用于复杂的骨盆重建和食管闭锁修复后的吻合口灌注。尽管它的肝吸收和胆汁排泄使其成为描绘Kasai门肠吻合术中解剖平面并识别原发性和转移性肝母细胞瘤病变的绝佳药物。皮下和淋巴内ICG注射可以识别医源性乳糜漏，并提高前哨淋巴结活检的产量。ICG引导的手术有望在儿科手术条件下更广泛地使用，和疗效的持续评估将是必要的，以更好地为临床实践提供信息，并确定在哪里集中和开发这种技术资源。
