增强现实导航联合荧光腹腔镜技术在肝中叶肿瘤切除术中的应用

Application of augmented reality navigation combined with indocyanine green fluorescence imaging in laparoscopic resection of central hepatic tumors

摘要:

背景与目的 肝中叶肿瘤解剖位置复杂，邻近第一、第二肝门及重要肝静脉系统，腹腔镜下精准定位肿瘤边界及关键脉管结构难度较大。单纯依赖术中超声或吲哚菁绿荧光成像（ICG-FI）存在深部结构显示不足等局限。本文旨在探讨增强现实（AR）导航联合ICG-FI技术在腹腔镜肝中叶肿瘤切除术中的临床应用价值。方法 回顾性分析2022年5月—2025年3月皖南医学院第一附属医院肝胆外科应用AR导航联合ICG-FI技术行腹腔镜肝中叶肿瘤切除术的38例患者临床资料。观察术中导航效果、手术相关指标及围手术期结局。结果 38例患者均顺利完成手术，无中转开腹。肿瘤荧光显影率为100%。平均手术时间为（324.9±132.4）min，中位术中出血量为400（50~1 200）mL。平均配准误差为（6.3±0.6）mm。中位预测血管数为6（4~8）条，中位验证血管数为7（5~10）条。所有患者均实现R₀切除，平均切缘宽度为（1.5±0.5）cm。术后并发症发生率为13.2%，无腹腔出血、气体栓塞或肝衰竭等严重并发症。中位术后住院时间为9（4~20）d。中位随访时间20个月，未见肿瘤复发。结论 AR导航联合ICG-FI技术可在腹腔镜肝中叶肿瘤切除术中实现对关键脉管结构的术中预测与验证，精准控制肝切除平面，提高R₀切除率及手术安全性，具有良好的临床应用前景。

Abstract:

Background and Aims Laparoscopic resection of centrally located hepatic tumors remains technically demanding due to the complex anatomical relationships with major vascular structures. Conventional intraoperative ultrasound or indocyanine green fluorescence imaging (ICG-FI) alone has limitations, particularly in visualizing deep anatomical structures. This study aimed to evaluate the clinical value of augmented reality (AR) navigation combined with ICG-FI in laparoscopic resection of central hepatic tumors.Methods A retrospective analysis was conducted on 38 consecutive patients who underwent laparoscopic resection of central hepatic tumors guided by AR navigation combined with ICG-FI between May 2022 and March 2025. Intraoperative navigation performance, surgical parameters, and perioperative outcomes were assessed.Results All 38 procedures were completed laparoscopically without conversion. The intraoperative tumor fluorescence detection rate was 100%. The mean operative time was (324.9 ± 132.4) min, and the median intraoperative blood loss was 400 (50-1 200) mL. The mean registration error was (6.3±0.6) mm. The median number of predicted and verified vessels was 6 (4-8) and 7 (5-10), respectively. R₀ resection was achieved in all patients, with a mean surgical margin of (1.5±0.5) cm. The postoperative complication rate was 13.2%, with no severe complications such as intra-abdominal hemorrhage, gas embolism, or liver failure. The median postoperative hospital stay was 9 (4-20) days. During a median follow-up of 20 months, no tumor recurrence was observed.Conclusion The combined use of AR navigation and ICG-FI enables intraoperative prediction and verification of critical vascular structures and facilitates precise control of the transection plane in laparoscopic resection of central hepatic tumors. This technique improves surgical precision and safety and shows promising clinical potential.