背景:本研究旨在探讨吲哚菁绿近红外荧光(ICG-NIR)荧光引导视频内镜腹股沟淋巴结清扫术(VEIL)治疗直肠癌腹股沟淋巴结转移(ILNM)的安全性和可行性。
方法:对11例行ICG-NIR荧光引导VEIL的直肠癌患者进行回顾性分析,评估各种参数,如运行时间,术中出血,收集的淋巴结数量,术中和术后并发症,和后续行动。
结果:关于ILNM的外科手术,单侧手术7例(54.5%),双侧手术4例(45.5%)。在11例ICG-NIR引导的VEIL手术中,在13例手术中实现了阳性荧光可视化(86.7%)。估计失血量的中位数为10ml,中位手术时间为90min。1例(6.7%)需要转换为开放手术。引流管的中位持续时间为12天,术后住院时间中位数为20天.术后观察并发症,其中切口感染2例(18.2%),淋巴漏5例(45.5%),泌尿系感染1例(9.1%),和肺炎3例(27.3%)。并发症如皮肤坏死,下肢静脉血栓形成,下肢肿胀,在术后随访期间观察到或运动受损。无原发灶,腹股沟,或盆腔淋巴结复发。
结论:ICG-NIR荧光引导的VEIL是治疗直肠癌伴ILNM的一种安全可行的手术方法。ICG荧光引导有望成为直肠癌手术中VEIL的一种更加个性化和精确的方法。
BACKGROUND: This study aimed to investigate the safety and feasibility of indocyanine green near-infrared fluorescence (ICG-NIR) fluorescence-guided video-endoscopic inguinal lymphadenectomy (VEIL) for rectal cancer with inguinal lymph node metastasis (ILNM).
METHODS: A retrospective analysis was conducted on 11 patients with rectal cancer who underwent ICG-NIR fluorescence-guided VEIL, assessing various parameters such as operation time, intraoperative bleeding, number of harvested lymph nodes, intraoperative and postoperative complications, and follow-up.
RESULTS: Regarding surgical procedures for ILNM, unilateral surgery was performed in 7 cases (54.5%) and bilateral surgery in 4 cases (45.5%). Among these 15 ICG-NIR-guided VEIL surgeries in 11 patients, positive fluorescence visualization was achieved in 13 operations (86.7%). The median estimated blood loss was 10 ml, and the median operation time was 90 min. One case (6.7%) required conversion to open surgery. The median duration of the drain tube was 12 days, and the median length of postoperative hospital stay was 20 days. Postoperative complications were observed, including incisional infection in 2 cases (18.2%), lymphatic leakage in 5 cases (45.5%), urinary infection in 1 case (9.1%), and pneumonia in 3 cases (27.3%). Complications such as skin necrosis, lower limb venous thrombosis, lower limb swelling, or impaired movement were observed during the postoperative follow-up period. No cases of primary lesion, groin, or pelvic lymph node recurrence were observed.
CONCLUSIONS: ICG-NIR fluorescence-guided VEIL is a safe and feasible surgical treatment for rectal cancer with ILNM. ICG fluorescence guidance holds promise as a more personalized and precise approach for VEIL in rectal cancer surgery.