Laparoscopic anatomic segment Ⅳ hepatectomy based on three-dimensional reconstruction and ICG fluorescence guidance_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Xiaobo ,  WEI Yonggang

Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

WEI Yonggang, Email: yourwyg@163.com

Keywords：

3D reconstruction; indocyanine green; anatomical hepatectomy

DOI：

10.7507/1007-9424.202107004

Video：

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Objective To investigate the clinical value of three-dimensional reconstruction of liver and resection of hepatocellular carcinoma with indocyanine green (ICG) fluorescence staining. Methods Clinical data of a patient with hepatocellular carcinoma admitted to the Department of Liver Surgery of West China Hospital of Sichuan University in May 2021 were retrospectively collected. In this patient, intrahepatic vascular reconstruction was performed by SYNAPSE 3D software of Japan before operation, and the portal vein and hepatic vein corresponding to the tumor were analyzed to simulate the resection range. Intraoperative ICG fluorescence staining was used to perform laparoscopic resection of segment Ⅳ of the liver.Results In this patient, the fluorescence boundary on the liver surface was clear after staining, and the intrahepatic segment fluorescence interface could still be maintained in the hepatic parenchyma dissociation, and the resection of the liver segment was consistent with the preoperative three-dimensional reconstruction plan. The operation took 230 min in total, and the bleeding was about 200 mL. On the first day after the operation, blood biochemical test showed that the plasma albumin was slightly low, and no obvious abnormalities were observed in transaminase, bilirubin, etc. After the infusion of human albumin, the indexes returned to normal, and the patient recovered and was discharged on the fourth day after the operation. No complications occurred after the operation, and no tumor recurrence and metastasis were observed during follow-up period. Conclusion 3D reconstruction and ICG fluorescence guidance are safe and feasible for the treatment of hepatocellular carcinoma after laparoscopic anatomic segment Ⅳ resection, and the positive staining method of ICG fluorescence segment is recommended.

Citation： WANG Xiaobo, WEI Yonggang. Laparoscopic anatomic segment Ⅳ hepatectomy based on three-dimensional reconstruction and ICG fluorescence guidance. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(12): 1632-1636. doi: 10.7507/1007-9424.202107004 Copy

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2.	曾思略, 曾宁, 祝文, 等. 三维可视化联合吲哚菁绿荧光影像技术在原发性肝癌诊治中的价值. 南方医科大学学报, 2019, 39(12): 1402-1408.
3.	崔楷悦, 董蒨, 耿耿, 等. 基于计算机辅助手术系统的肝静脉分型及其对肝脏外科的临床意义. 中华肝胆外科杂志, 2017, 23(9): 585-590.
4.	王宏光. 吲哚菁绿肝段染色在腹腔镜肝癌切除中应用及意义. 中国实用外科杂志, 2018, 38(4): 376-378.
5.	王鹏飞, 陈明易, 卢实春, 等. 吲哚菁绿荧光引导腹腔镜解剖性肝脏Ⅵ段切除手术流程. 中华肝胆外科杂志, 2019, 25(3): 228-229.
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8.	叶钢, 张涛, 王勋, 等. 腹腔镜下吲哚菁绿双荧光染色解剖性肝Ⅳb段切除治疗肝细胞癌. 腹部外科, 2020, 33(3): 180-183, 189.
9.	张雯雯, 陈明易, 王宏光. 荧光腹腔镜解剖性肝脏Ⅵ段切除术1例. 肝癌电子杂志, 2020, 7(2): 73-75.
10.	周磊, 卜浩, 成伟, 等. 腹腔镜解剖性肝脏Ⅱ段切除手术流程. 中华肝胆外科杂志, 2019, 25(2): 140-141.
11.	王鹏飞, 陈明易, 卢实春, 等. 吲哚菁绿荧光引导腹腔镜解剖性肝脏Ⅶ段切除手术流程. 中华肝胆外科杂志, 2019, 25(2): 137-139.
12.	刘允怡, 刘晓欣. 三维可视化技术在肝脏外科临床应用的优势. 中华外科杂志, 2016, 54(9): 661-663.
13.	刘磊, 赵义军. 三维重建技术在精准肝切除中的应用进展. 肝胆外科杂志, 2021, 29(1): 74-76.
14.	李鹏鹏, 王志恒, 黄罡, 等. 肝脏三维可视化技术在肝脏恶性肿瘤治疗规划中的应用研究. 中华外科杂志, 2017, 55(12): 916-922.
15.	卢鹏, 王宏光. 吲哚菁绿荧光引导腹腔镜解剖性肝段切除术. 中华消化外科杂志, 2020, 19(2): 139-144.
16.	李博, 林杰. 肝脏三维重建技术较传统CT成像技术对肿瘤体积可提供更准确的术前评估. 中国组织工程研究, 2020, 24(11): 1726-1732.
17.	王伟, 胡娟英, 许明辉, 等. 肝脏三维重建术前规划结合术中超声引导在腹腔镜精准肝段切除的临床效果. 浙江创伤外科, 2021, 26(2): 221-222.
18.	曾思略, 杨剑, 祝文, 等. 三维可视化、虚拟现实技术联合ICG分子荧光成像在中央型肝癌肝切除术中的应用 (附视频). 中华肝脏外科手术学电子杂志, 2019, 8(5): 420-425.
19.	季渝军. 基于Amira软件的三维立体重建技术在精准肝切除术中的应用研究. 影像科学与光化学, 2020, 38(5): 801-806.
20.	张思琦, 王晶, 陈钟, 等. 三维影像分析系统在肝脏肿瘤精准切除中的应用研究. 交通医学, 2020, 34(2): 140-142.
21.	宋研, 张建淮, 禹亚彬, 等. 三维重建可视化技术在精准肝脏外科研究生教学和规范化培训中的应用. 中国临床研究, 2020, 33(10): 1403-1406.
22.	白军军, 翟振洪, 季德刚, 等. 数字化三维重建技术在肝脏外科中的应用. 医院与医学, 2018, 6(2): 14-18.

1. Ishizawa T, Gumbs AA, Kokudo N, et al. Laparoscopic segmentectomy of the liver: from segment Ⅰ to Ⅷ. Ann Surg, 2012, 256(6): 959-964.
2. 曾思略, 曾宁, 祝文, 等. 三维可视化联合吲哚菁绿荧光影像技术在原发性肝癌诊治中的价值. 南方医科大学学报, 2019, 39(12): 1402-1408.
3. 崔楷悦, 董蒨, 耿耿, 等. 基于计算机辅助手术系统的肝静脉分型及其对肝脏外科的临床意义. 中华肝胆外科杂志, 2017, 23(9): 585-590.
4. 王宏光. 吲哚菁绿肝段染色在腹腔镜肝癌切除中应用及意义. 中国实用外科杂志, 2018, 38(4): 376-378.
5. 王鹏飞, 陈明易, 卢实春, 等. 吲哚菁绿荧光引导腹腔镜解剖性肝脏Ⅵ段切除手术流程. 中华肝胆外科杂志, 2019, 25(3): 228-229.
6. Ueno M, Hayami S, Sonomura T, et al. Indocyanine green fluorescence imaging techniques and interventional radiology during laparoscopic anatomical liver resection (with video). Surg Endosc, 2018, 32(2): 1051-1055.
7. 王晓颖, 高强, 朱晓东, 等. 腹腔镜超声联合三维可视化技术引导门静脉穿刺吲哚菁绿荧光染色在精准解剖性肝段切除术中的应用. 中华消化外科杂志, 2018, 17(5): 452-458.
8. 叶钢, 张涛, 王勋, 等. 腹腔镜下吲哚菁绿双荧光染色解剖性肝Ⅳb段切除治疗肝细胞癌. 腹部外科, 2020, 33(3): 180-183, 189.
9. 张雯雯, 陈明易, 王宏光. 荧光腹腔镜解剖性肝脏Ⅵ段切除术1例. 肝癌电子杂志, 2020, 7(2): 73-75.
10. 周磊, 卜浩, 成伟, 等. 腹腔镜解剖性肝脏Ⅱ段切除手术流程. 中华肝胆外科杂志, 2019, 25(2): 140-141.
11. 王鹏飞, 陈明易, 卢实春, 等. 吲哚菁绿荧光引导腹腔镜解剖性肝脏Ⅶ段切除手术流程. 中华肝胆外科杂志, 2019, 25(2): 137-139.
12. 刘允怡, 刘晓欣. 三维可视化技术在肝脏外科临床应用的优势. 中华外科杂志, 2016, 54(9): 661-663.
13. 刘磊, 赵义军. 三维重建技术在精准肝切除中的应用进展. 肝胆外科杂志, 2021, 29(1): 74-76.
14. 李鹏鹏, 王志恒, 黄罡, 等. 肝脏三维可视化技术在肝脏恶性肿瘤治疗规划中的应用研究. 中华外科杂志, 2017, 55(12): 916-922.
15. 卢鹏, 王宏光. 吲哚菁绿荧光引导腹腔镜解剖性肝段切除术. 中华消化外科杂志, 2020, 19(2): 139-144.
16. 李博, 林杰. 肝脏三维重建技术较传统CT成像技术对肿瘤体积可提供更准确的术前评估. 中国组织工程研究, 2020, 24(11): 1726-1732.
17. 王伟, 胡娟英, 许明辉, 等. 肝脏三维重建术前规划结合术中超声引导在腹腔镜精准肝段切除的临床效果. 浙江创伤外科, 2021, 26(2): 221-222.
18. 曾思略, 杨剑, 祝文, 等. 三维可视化、虚拟现实技术联合ICG分子荧光成像在中央型肝癌肝切除术中的应用 (附视频). 中华肝脏外科手术学电子杂志, 2019, 8(5): 420-425.
19. 季渝军. 基于Amira软件的三维立体重建技术在精准肝切除术中的应用研究. 影像科学与光化学, 2020, 38(5): 801-806.
20. 张思琦, 王晶, 陈钟, 等. 三维影像分析系统在肝脏肿瘤精准切除中的应用研究. 交通医学, 2020, 34(2): 140-142.
21. 宋研, 张建淮, 禹亚彬, 等. 三维重建可视化技术在精准肝脏外科研究生教学和规范化培训中的应用. 中国临床研究, 2020, 33(10): 1403-1406.
22. 白军军, 翟振洪, 季德刚, 等. 数字化三维重建技术在肝脏外科中的应用. 医院与医学, 2018, 6(2): 14-18.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Laparoscopic anatomic segment Ⅳ hepatectomy based on three-dimensional reconstruction and ICG fluorescence guidance

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