ICG荧光导航联合Laennec膜入路在腹腔镜左半肝切除术的应用

Application of ICG fluorescence navigation combined with the Laennec's capsule approach in laparoscopic left hepatectomy

摘要:

背景与目的 在腹腔镜左半肝切除术中，精准定位病变与优化手术路径至关重要。传统手术方式存在一定局限性，而吲哚菁绿（ICG）荧光导航可精准显示肝脏内病变边界，Laennec膜入路有助于清晰解剖肝内结构，本研究探讨ICG荧光导航联合Laennec膜入路在腹腔镜左半肝切除术的临床应用效果。方法 回顾性收集2023年1月—2024年11月四川省宣汉县人民医院肝胆外科收治的44例肝癌患者的病历资料。其中22例采用高清腹腔镜下Pringle法全肝血流阻断左半肝切除术（对照组），另22例应用ICG荧光导航联合Laennec膜入路行腹腔镜左半肝切除术（观察组）。比较两组术中手术平均时间、手术平均出血量、术中输血率；术后第1、3、7天的肝功能［总胆红素（TBIL）、天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）］和术后平均住院时间、胃肠功能恢复时间、术后1~6 d腹腔引流量、术后并发症发生率及近期疗效。结果 观察组平均手术时间短于对照组［（218.19±39.18）min vs. （245.23±44.36）min，P<0.05］、手术平均出血量少于对照组［（320.44±78.62）mL vs. （456.37±88.16）mL，P<0.05］，对照组与观察组术中输血率差异无统计学意义（13.64% vs. 9.09%，P>0.05）。观察组术后1~6 d腹腔引流量少于对照组［（431.19±152.18）mL vs. （528.23±184.36）mL，P<0.05］，术后平均住院时间、胃肠功能恢复时间均短于对照组［（9.21±2.92）d vs. （12.72±3.24）d；（2.24±0.42）d vs. （3.35±0.53）d，均P<0.05］。观察组术后第1、3、7天TBIL、AST、ALT水平均低于对照组（均P<0.05）。对照组与观察组总有效率差异无统计学意义（72.73% vs. 77.27%，P>0.05），两组术后均未发生严重并发症。结论 ICG荧光导航联合Laennec膜入路在腹腔镜左半肝切除术的临床应用效果较好，值得临床推广。

Abstract:

Background and Aims Precise localization of lesions and optimization of the surgical approach are crucial in laparoscopic left hepatectomy. Traditional surgical techniques have certain limitations, whereas indocyanine green (ICG) fluorescence navigation can accurately delineate the boundaries of liver lesions. The Laennec's capsule approach aids in clearly exposing intrahepatic structures. This study was conducted to evaluate the clinical effectiveness of combining ICG fluorescence navigation with the Laennec's capsule approach in laparoscopic left hepatectomy.Methods The clinical data of 44 liver cancer patients who underwent surgery at the Hepatobiliary Surgery Department of Xuanhan People's Hospital from January 2023 to November 2024 were retrospectively collected. Among them, 22 patients underwent laparoscopic left hepatectomy with Pringle's maneuver for total hepatic inflow occlusion (control group), while the other 22 patients received laparoscopic left hepatectomy using ICG fluorescence navigation combined with the Laennec's capsule approach (observation group). The two groups were compared in terms of intraoperative surgical time, average blood loss, intraoperative transfusion rate, liver function on postoperative days (POD) 1, 3, and 7 [total bilirubin (TBIL), aspartate aminotransferase (AST), alanine aminotransferase (ALT)], average length of hospital stay, gastrointestinal function recovery time, POD 1-6 drainage volume, incidence of postoperative complications, and short-term efficacy.Results The observation group had significantly shorter average surgical time than the control group [(218.19±39.18) min vs. (245.23±44.36) min, P<0.05] and less average blood loss [(320.44±78.62) mL vs. (456.37±88.16) mL, P<0.05]. The intraoperative transfusion rate between the two groups was not significantly different (13.64% vs. 9.09%, P>0.05). The observation group had significantly less postoperative drainage POD 1-6 than the control group [(431.19±152.18) mL vs. (528.23±184.36) mL, P<0.05]. The average hospital stay and gastrointestinal function recovery time were shorter in the observation group [(9.21±2.92) d vs. (12.72±3.24) d; (2.24±0.42) d vs. (3.35±0.53) d, both P<0.05]. Postoperative liver function tests (TBIL, AST, ALT) on days 1, 3, and 7 were significantly lower in the observation group compared to the control group (all P<0.05). The difference in the overall response rate between the two groups was not statistically significant (72.73% vs. 77.27%, P>0.05). No severe postoperative complications occurred in either group.Conclusion The combination of ICG fluorescence navigation with the Laennec's capsule approach demonstrates favorable clinical outcomes in laparoscopic left hepatectomy and is worthy of clinical promotion.