三维重建联合吲哚菁绿术中导航在肝癌诊断和治疗中的应用

doi:10.13481/j.1671-587X.20210427

Abstract

Abstract: Objective

To evaluate the application value of three-dimensional reconstruction technology combined with indocyanine green（ICG） fluorescence staining in the diagnosis and treatment of liver tumor， and to explore whether the combined technology can help reduce the incidence of postoperative complications.

Methods

Using retrospective research method， the clinical data of 70 patients with liver cancer were collected； according to whether the patients underwent 3D reconstruction combined with IGF navigation， they were divided into routine preoperative evaluation and hepatectomy group （conventional group） and three-dimensional reconstruction combined with IGF intraoperative navigation group （combined group）. The detection and resection of intraoperative lesions， intraoperative blood loss and blood transfusion， operation time， time of postoperative hospital stay， Clavien-Dindo complication classification， and the incidence of major complications after liver resection defined by the International Study Group of Liver Surgery （ISGLS） of the patients were recorded.

Results

In combined group， 15 new lesions were found by intraoperative ICG staining compared with preoperative CT/MRI. The pathological results confirmed that 4 cases were hepatocellular carcinoma， 2 cases were colon cancer liver metastases， and the remaining 9 cases were cirrhotic nodules. The sensitivity was 95.35% and the specificity was 68.75%. Compared with conventional group，the operation time of the patients in combined group was shortened （P<0.05），the Clavie-Dindo complication classification was improved （P<0.05）； there were no significant differences in the blood loss，the blood transfusion，the time of postoperative hospital stay， and the incidence of complications defined by ISGLS （P>0.05）. The surgical margins of the patients in two groups corresponded the R0 resection standard， and one patient in conventional group presented tumor recurrence at the reexamination 3 months after surgery.

Conclusion

Three-dimensional reconstruction technology combined with ICG staining can improve the safety of the operation and achieve precise positioning through sufficient preoperative evaluation and approach planning， which can effectively shorten the operation time， increase the detection rate of the lesion，has a certain positive impact on reducing the incidence of postoperative complications， and achieves the precise liver resection.

Key words: liver neoplasms, indocyanine green, optical imaging, navigation, three-dimensional reconstruction

CLC Number:

R735.7

Tianyi WANG,Yufeng ZHU,Miao SUN,Wei WANG. Application of three-dimensional reconstruction combined with indocyanine green intraoperative navigation in diagnosis and treatment of liver cancer[J].Journal of Jilin University(Medicine Edition), 2021, 47(4): 1014-1021.

Figures/Tables 5

Tab.1

Fig. 1

Fig. 2

Tab.2

Tab.3

References 33

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Group	n	Gender			Age(year)	Hepatitis	Cirrhosis
Group	n	Female		Male	Age(year)	Hepatitis	Cirrhosis
Conventional	36	14		22	59.17±9.24	16	14
Combined	34	16		18	54.18±14.42	14	18
t/χ²		0.477			－1.713	0.076	1.391
P		0.490			0.092	0.782	0.238
Group	n	Child-pugh classification			AFP （≥400 μg·L^－1）	Number of lesions
Group	n	A	B		AFP （≥400 μg·L^－1）	Number of lesions
Conventional	36	33	3		7	9
Combined	34	32	2		7	7
t/χ²		0.000			0.014	0.193
P		1.000			0.905	0.660

Group	n	Operation time (t/min)			Intraoperative blood loss (V/mL)		Number of blood transfusion (n)
Conventional	36	186.94±60.15			100(368)		8
Combined	34	161.76±40.58			150(225)		4
t/χ²		－2.041			－0.448		1.346
P		0.045			0.654		0.246
Group	n	Time of postoperative hospital stay (t/d)			Bile leakage	Hepatic failure	Postoperative hemorrhage
Conventional	36	11.58±4.96			4	1	2
Combined	34	9.74±2.99			1	0	0
t/χ²		－1.305			0.743	0.000	0.458
P		0.192			0.389	1.000	0.499
Group	n	Clavien-Dindo classification					R0 resection	Recurrence
Group	n	GradeⅠ	Grade Ⅱ	Grade Ⅲ	Grade Ⅳ	Grade Ⅴ	R0 resection	Recurrence
Conventional	36	3	9	1	0	2	36	1
Combined	34	7	3	0	0	1	34	0
t/χ²		－2.005						0.000
P		0.045						1.000

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Application of three-dimensional reconstruction combined with indocyanine green intraoperative navigation in diagnosis and treatment of liver cancer

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Group	Method	Number of lesions	Number of malignant tumor	Number of benign lesions
Conventional	CT/MRI	45	37	8
	IOUS	50	38	12
Combined	CT/MRI	44	37	7
	ICG	59	43	16
	IOUS	59	43	16