《胰腺肿瘤的荧光手术导航：国际专家共识》解读与思考

Interpretation and reflections on the international consensus report on fluorescent surgery navigation for pancreatic tumors

摘要:

吲哚菁绿（ICG）是目前临床获批用于荧光引导手术的近红外造影剂之一，尽管已被广泛应用，但其目前仍有一些局限性。近年来，已有多种靶向荧光造影剂在胰腺癌患者中展开探索性研究，然而，关于胰腺癌荧光引导手术的标准化实践，外科领域尚未形成统一共识。2023年，国际上首次发布《胰腺肿瘤的荧光手术导航：国际专家共识》，汇集了来自全球38位胰腺外科专家关于当前应用现状与未来发展方向的意见，并通过德尔菲法对76条相关声明进行了匿名投票，最终形成61条推荐意见。该共识为我国开展胰腺肿瘤荧光引导手术提供了重要参考，但在临床推广过程中，仍需结合国内专家的意见及本土患者特点加以优化。本文围绕共识中关于ICG的使用、术中荧光成像技术以及胰腺肿瘤的荧光异质性等关键内容，结合笔者临床经验加以解读与思考，以期为胰腺肿瘤荧光手术导航的临床实践提供借鉴与启示。

Abstract:

Indocyanine green (ICG) is one of the near-infrared fluorescent contrast agents approved for clinical use in fluorescence-guided surgery. Although widely applied, it still has some limitations. In recent years, various targeted fluorescent agents have been explored in pancreatic cancer patients; however, there is still no standardized consensus among surgeons regarding fluorescence-guided surgery for pancreatic cancer. In 2023, the first the international consensus report on fluorescent surgery navigation for pancreatic tumors was published, gathering perspectives from 38 pancreatic surgeons worldwide on current practices and future directions. A total of 76 statements were anonymously voted on using the Delphi method, resulting in 61 recommended statements. This consensus offers valuable guidance for the implementation of fluorescence-guided surgery in pancreatic tumor operations in China, yet its clinical application should be adapted in consideration of local expert opinions and patient-specific factors. This article interprets key aspects of the consensus, including the use of ICG, intraoperative fluorescence imaging techniques, and the fluorescence heterogeneity of pancreatic tumors, in combination with the authors' clinical experience, with the aim of providing reference and insight for the application of fluorescence-guided surgery in pancreatic tumors.