吲哚菁绿标记近红外荧光腹腔镜胃癌根治术的应用价值评估
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摘要
目的:研究吲哚菁绿标记近红外荧光腹腔镜系统在腹腔镜胃癌根治术淋巴结清扫、重建后消化道血供评估及肿瘤定位中的应用价值。方法:回顾分析2017年12月至2019年1月收治的经胃镜及病理确诊的87例胃癌患者的临床资料,其中42例在吲哚菁绿标记近红外荧光腹腔镜系统下完成手术(观察组),45例行常规腹腔镜手术(对照组),对比术后两组淋巴结清扫与分检情况,并探讨吲哚菁绿标记在术中肿瘤定位及评估重建后消化道血供的作用。结果:观察组平均清扫淋巴结(36.71±11.43)枚,高于对照组的(31.22±8.67)枚(P<0.05);观察组检出直径<5 mm的淋巴结数量为(23.25±3.28)枚,高于对照组的(17.43±4.08)枚(P<0.05)。两组患者阳性淋巴结检出率差异无统计学意义(P>0.05)。根据吲哚菁绿评估血供的标准,观察组吻合口及十二指肠残端血供评分均达到3分以上,术后无一例发生消化道瘘。吲哚菁绿标记的胃浆膜层荧光范围边缘与肿瘤边缘的距离均超过胃癌根治术切除范围的标准距离。结论:吲哚菁绿标记近红外荧光腹腔镜胃癌根治术是安全、可行的,其淋巴结示踪作用可指导术者更精细、彻底地清扫淋巴结,术中应用吲哚菁绿评估吻合口血供可有效避免术后消化道瘘的发生,而且吲哚菁绿标记可精准定位肿瘤,进而指导腹腔镜胃癌根治术的切除范围。
Objective: To evaluate the clinical application of near-infrared( NIR) camera imaging with indocyanine green( ICG)-enhanced fluorescence technique in laparoscopic radical gastrectomy.Methods: Retrospective analysis was made on the clinical data of 87 patients who underwent laparoscopic radical gastrectomy with D2 lymph node dissection between Dec.2017 and Jan.2019 in Qilu hospital of Shandong University. 42 patients received the radical gastrectomy under ICG-NIR laparoscopic system( observation group),and the rest 45 patients received the normal laparoscopic radical gastrectomy served as the control group.Through comparison of the lymph node harvested,the significance of ICG-NIR laparoscopic system in lymph node dissection,tumor localization and anastomotic perfusion were evaluated.Results: The mean number of dissected lymph nodes and lymph nodes smaller than 5 mm in diameter in observation group were both significantly higher than those in control group,respectively( 36.71 ± 11.43 vs. 31.22 ± 8.67,23.25 ± 3.28 vs.17.43±4.08,P<0.05).While the number of metastatic lymph nodes showed no significant difference between the two groups( P>0.05).According to the Sherwinter grading system,the scores of anastomotic perfusion were all ≥ 3,and no anastomotic fistula were observed in observation group.The mean distance between the borders of tumors and the fluorescent region area all exceeded the standard dissective distance of radical gastrectomy,which was helpful in tumor localization and determining the resection margin during laparoscopic gastrectomy.Conclusions: The NIR camera imaging with ICG-enhanced fluorescence technique in laparoscopic radical gastrectomy is safe and feasible,and it is helpful and effective for lymph node dissection,tumor localization and anastomotic perfusion evaluation during the laparoscopic radical gastrectomy.
Objective: To evaluate the clinical application of near-infrared( NIR) camera imaging with indocyanine green( ICG)-enhanced fluorescence technique in laparoscopic radical gastrectomy.Methods: Retrospective analysis was made on the clinical data of 87 patients who underwent laparoscopic radical gastrectomy with D2 lymph node dissection between Dec.2017 and Jan.2019 in Qilu hospital of Shandong University. 42 patients received the radical gastrectomy under ICG-NIR laparoscopic system( observation group),and the rest 45 patients received the normal laparoscopic radical gastrectomy served as the control group.Through comparison of the lymph node harvested,the significance of ICG-NIR laparoscopic system in lymph node dissection,tumor localization and anastomotic perfusion were evaluated.Results: The mean number of dissected lymph nodes and lymph nodes smaller than 5 mm in diameter in observation group were both significantly higher than those in control group,respectively( 36.71 ± 11.43 vs. 31.22 ± 8.67,23.25 ± 3.28 vs.17.43±4.08,P<0.05).While the number of metastatic lymph nodes showed no significant difference between the two groups( P>0.05).According to the Sherwinter grading system,the scores of anastomotic perfusion were all ≥ 3,and no anastomotic fistula were observed in observation group.The mean distance between the borders of tumors and the fluorescent region area all exceeded the standard dissective distance of radical gastrectomy,which was helpful in tumor localization and determining the resection margin during laparoscopic gastrectomy.Conclusions: The NIR camera imaging with ICG-enhanced fluorescence technique in laparoscopic radical gastrectomy is safe and feasible,and it is helpful and effective for lymph node dissection,tumor localization and anastomotic perfusion evaluation during the laparoscopic radical gastrectomy.
引文
[1]中华人民共和国国家卫生健康委员会.胃癌诊疗规范(2018版)[EB/OL].[2018-12-21].http://www.nhc.gov.cn/yzygj/s7659/201812/b21802b199814ab7b1219b87de0cae51.shtml.
[2]Yang L,Zheng R,Wang N,et al.Incidence and mortality of stomach cancer in China,2014[J].Chin J Cancer Res,2018,30(3):291-298.
[3]Bray F,Ferlay J,Soerjomataram I,et al.Global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J].CA Cancer J Clin,2018,68(6):394-424.
[4]彭智.GLOBCAN胃癌流行病学数据解读[J/CD].肿瘤综合治疗电子杂志,2018,4(4):63-65.
[5]中华人民共和国国家卫生和计划生育委员会.胃癌规范化诊疗指南(试行)[S/CD].中国医学前沿杂志(电子版),2013,5(8):56-63.
[6]中华医学会外科学分会腹腔镜与内镜外科学组,中国研究型医院学会机器人与腹腔镜外科专业委员会.腹腔镜胃癌手术操作指南(2016版)[S].中华消化外科杂志,2016,15(9):851-857.
[7]Japanese Gastric Cancer Association.Japanese gastric cancer treatment guidelines 2014(ver.4)[J].Gastric Cancer,2017,20(1):1-19.
[8]胡永利,张再重,王冰,等.进展期胃癌腹腔镜手术的发展及现状[J].腹腔镜外科杂志,2018,23(1):76-80.
[9]中国临床肿瘤学会(Csco).胃癌诊疗指南(2018版)[EB/OL].[2018-11-14].http://www.csco.org.cn/cat/147/show/8627.html.
[10]Takeuchi H,Kitagawa Y.Minimally invasive function-preserving surgery based on sentinel node concept in early gastric cancer[J].Transl Gastroenterol Hepatol,2016,1:23.
[11]麦麦提·艾合麦提,刘少壮,陈成,等.术前胃镜下纳米碳标记在腹腔镜胃癌根治术中的应用价值[J].腹腔镜外科杂志,2018,23(1):31-35.
[12]贾荣保,姜立新,姚增武,等.纳米碳示踪剂在腹腔镜胃癌淋巴结清扫术中的临床研究[J].腹腔镜外科杂志,2018,23(1):36-39.
[13]洪强,汪勇,王建军,等.术前胃镜下注射法纳米碳淋巴结示踪技术在腹腔镜胃癌根治术中的应用[J].中华医学杂志,2017,97(2):123-126.
[14]Li Z,Ao S,Bu Z,et al.Clinical study of harvesting lymph nodes with carbon nanoparticles in advanced gastric cancer:a prospective randomized trial[J].World J Surg Oncol,2016,14:88.
[15]Kwon IG,Son T,Kim HI,et al.Fluorescent Lymphography-Guided Lymphadenectomy During Robotic Radical Gastrectomy for Gastric Cancer[J].JAMA Surg,2018 Nov 14.[Epub ahead of print]
[16]Kim TH,Kong SH,Park JH,et al.Assessment of the Completeness of Lymph Node Dissection Using Near-infrared Imaging with Indocyanine Green in Laparoscopic Gastrectomy for Gastric Cancer[J].J Gastric Cancer,2018,18(2):161-171.
[17]Lan YT,Huang KH,Chen PH,et al.A pilot study of lymph node mapping with indocyanine green in robotic gastrectomy for gastric cancer[J].SAGE Open Med,2017,5:2050312117727444.
[18]Huh YJ,Lee HJ,Kim TH,et al.Efficacy of Assessing Intraoperative Bowel Perfusion with Near-Infrared Camera in Laparoscopic Gastric Cancer Surgery[J].J Laparoendosc Adv Surg Tech A,2018 Dec 27.[Epub ahead of print]
[19]Tajima Y,Yamazaki K,Masuda Y,et al.Sentinel node mapping guided by indocyanine green fluorescence imaging in gastric cancer[J].Ann Surg,2009,249(1):58-62.
[20]Kinami S,Kosaka T.Laparoscopic sentinel node navigation surgery for early gastric cancer[J].Transl Gastroenterol Hepatol,2017,2:42.
[21]魏猛,李真,陈成,等.吲哚菁绿标记全荧光腹腔镜根治性远端胃切除术(毕Ⅱ式吻合)1例报告---"第二十五届全国腹腔镜手术演示研讨会"首次使用Stryker Pinpoint荧光腹腔镜在全国范围内进行手术直播[J].腹腔镜外科杂志,2018,23(11):872-875.
[22]Sherwinter DA,Gallagher J,Donkar T.Intra-operative transanal near infrared imaging of colorectal anastomotic perfusion:a feasibility study[J].Colorectal Dis,2013,15(1):91-96.
[23]Hu Y,Huang C,Sun Y,et al.Morbidity and Mortality of Laparoscopic Versus Open D2 Distal Gastrectomy for Advanced Gastric Cancer:A Randomized Controlled Trial[J].J Clin Oncol,2016,34(12):1350-1357.
[24]CHERRICK GR,STEIN SW,LEEVY CM,et al.Indocyanine green:observations on its physical properties,plasma decay,and hepatic extraction[J].J Clin Invest,1960,39:592-600.
[25]Desmettre T,Devoisselle JM,Mordon S.Fluorescence properties and metabolic features of indocyanine green(ICG)as related to angiography[J].Surv Ophthalmol,2000,45(1):15-27.
[26]Alford R,Simpson HM,Duberman J,et al.Toxicity of organic fluorophores used in molecular imaging:literature review[J].Mol Imaging,2009,8(6):341-354.
[27]Reinhart MB,Huntington CR,Blair LJ,et al.Indocyanine Green:Historical Context,Current Applications,and Future Considerations[J].Surg Innov,2016,23(2):166-175.
[28]Kitai T,Inomoto T,Miwa M,et al.Fluorescence navigation with indocyanine green for detecting sentinel lymph nodes in breast cancer[J].Breast Cancer,2005,12(3):211-215.
[2]Yang L,Zheng R,Wang N,et al.Incidence and mortality of stomach cancer in China,2014[J].Chin J Cancer Res,2018,30(3):291-298.
[3]Bray F,Ferlay J,Soerjomataram I,et al.Global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J].CA Cancer J Clin,2018,68(6):394-424.
[4]彭智.GLOBCAN胃癌流行病学数据解读[J/CD].肿瘤综合治疗电子杂志,2018,4(4):63-65.
[5]中华人民共和国国家卫生和计划生育委员会.胃癌规范化诊疗指南(试行)[S/CD].中国医学前沿杂志(电子版),2013,5(8):56-63.
[6]中华医学会外科学分会腹腔镜与内镜外科学组,中国研究型医院学会机器人与腹腔镜外科专业委员会.腹腔镜胃癌手术操作指南(2016版)[S].中华消化外科杂志,2016,15(9):851-857.
[7]Japanese Gastric Cancer Association.Japanese gastric cancer treatment guidelines 2014(ver.4)[J].Gastric Cancer,2017,20(1):1-19.
[8]胡永利,张再重,王冰,等.进展期胃癌腹腔镜手术的发展及现状[J].腹腔镜外科杂志,2018,23(1):76-80.
[9]中国临床肿瘤学会(Csco).胃癌诊疗指南(2018版)[EB/OL].[2018-11-14].http://www.csco.org.cn/cat/147/show/8627.html.
[10]Takeuchi H,Kitagawa Y.Minimally invasive function-preserving surgery based on sentinel node concept in early gastric cancer[J].Transl Gastroenterol Hepatol,2016,1:23.
[11]麦麦提·艾合麦提,刘少壮,陈成,等.术前胃镜下纳米碳标记在腹腔镜胃癌根治术中的应用价值[J].腹腔镜外科杂志,2018,23(1):31-35.
[12]贾荣保,姜立新,姚增武,等.纳米碳示踪剂在腹腔镜胃癌淋巴结清扫术中的临床研究[J].腹腔镜外科杂志,2018,23(1):36-39.
[13]洪强,汪勇,王建军,等.术前胃镜下注射法纳米碳淋巴结示踪技术在腹腔镜胃癌根治术中的应用[J].中华医学杂志,2017,97(2):123-126.
[14]Li Z,Ao S,Bu Z,et al.Clinical study of harvesting lymph nodes with carbon nanoparticles in advanced gastric cancer:a prospective randomized trial[J].World J Surg Oncol,2016,14:88.
[15]Kwon IG,Son T,Kim HI,et al.Fluorescent Lymphography-Guided Lymphadenectomy During Robotic Radical Gastrectomy for Gastric Cancer[J].JAMA Surg,2018 Nov 14.[Epub ahead of print]
[16]Kim TH,Kong SH,Park JH,et al.Assessment of the Completeness of Lymph Node Dissection Using Near-infrared Imaging with Indocyanine Green in Laparoscopic Gastrectomy for Gastric Cancer[J].J Gastric Cancer,2018,18(2):161-171.
[17]Lan YT,Huang KH,Chen PH,et al.A pilot study of lymph node mapping with indocyanine green in robotic gastrectomy for gastric cancer[J].SAGE Open Med,2017,5:2050312117727444.
[18]Huh YJ,Lee HJ,Kim TH,et al.Efficacy of Assessing Intraoperative Bowel Perfusion with Near-Infrared Camera in Laparoscopic Gastric Cancer Surgery[J].J Laparoendosc Adv Surg Tech A,2018 Dec 27.[Epub ahead of print]
[19]Tajima Y,Yamazaki K,Masuda Y,et al.Sentinel node mapping guided by indocyanine green fluorescence imaging in gastric cancer[J].Ann Surg,2009,249(1):58-62.
[20]Kinami S,Kosaka T.Laparoscopic sentinel node navigation surgery for early gastric cancer[J].Transl Gastroenterol Hepatol,2017,2:42.
[21]魏猛,李真,陈成,等.吲哚菁绿标记全荧光腹腔镜根治性远端胃切除术(毕Ⅱ式吻合)1例报告---"第二十五届全国腹腔镜手术演示研讨会"首次使用Stryker Pinpoint荧光腹腔镜在全国范围内进行手术直播[J].腹腔镜外科杂志,2018,23(11):872-875.
[22]Sherwinter DA,Gallagher J,Donkar T.Intra-operative transanal near infrared imaging of colorectal anastomotic perfusion:a feasibility study[J].Colorectal Dis,2013,15(1):91-96.
[23]Hu Y,Huang C,Sun Y,et al.Morbidity and Mortality of Laparoscopic Versus Open D2 Distal Gastrectomy for Advanced Gastric Cancer:A Randomized Controlled Trial[J].J Clin Oncol,2016,34(12):1350-1357.
[24]CHERRICK GR,STEIN SW,LEEVY CM,et al.Indocyanine green:observations on its physical properties,plasma decay,and hepatic extraction[J].J Clin Invest,1960,39:592-600.
[25]Desmettre T,Devoisselle JM,Mordon S.Fluorescence properties and metabolic features of indocyanine green(ICG)as related to angiography[J].Surv Ophthalmol,2000,45(1):15-27.
[26]Alford R,Simpson HM,Duberman J,et al.Toxicity of organic fluorophores used in molecular imaging:literature review[J].Mol Imaging,2009,8(6):341-354.
[27]Reinhart MB,Huntington CR,Blair LJ,et al.Indocyanine Green:Historical Context,Current Applications,and Future Considerations[J].Surg Innov,2016,23(2):166-175.
[28]Kitai T,Inomoto T,Miwa M,et al.Fluorescence navigation with indocyanine green for detecting sentinel lymph nodes in breast cancer[J].Breast Cancer,2005,12(3):211-215.
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