【摘要】 目的探讨吲哚菁绿(indocyanine green,ICG)介导的近红外光在肝母细胞瘤中的显像特点,以及该技术对术中微小病灶识别、肿瘤切缘界定和术中导航的价值。方法 2018年3月至2018年6月由复旦大学附属儿科医院收治的拟切除肝母细胞瘤的患儿8例,术前至少24 h予以静脉注射ICG,术中切肝前进行肝脏微小病灶检测、肿瘤切缘界定和手术导航,切肝后进行切缘病灶检测和肿瘤荧光分型,最终与病理结果对比。结果 8例肝母细胞瘤中,男童和女童各4例,年龄5～132个月,平均33个月。术后复发再次手术1例,术前活检化疗后再手术1例,术前经验性化疗后再手术4例,2例一期行肝肿瘤切除术。术中8例患儿肿瘤都呈现明亮荧光显影,与正常肝脏组织边界清晰; 1例复发为微小病灶(1. 0 cm),但由于病灶位置较深(距离肝脏表面> 1. 5 cm),肉眼观察、扪诊和ICG荧光显像未能发现,规则切除肝叶后,ICG识别出复发病灶。根据荧光显影分型,全荧光4例,其中2例肝母细胞瘤一期行肿瘤切除术; 1例术前有活检和化疗史的病例; 1例为复发病例,其有肝炎和肝轻度硬化病史,同时伴有肝脏弥漫性小结节样影。部分荧光4例,均为术前有经验性化疗的病例。结合肝母细胞瘤的病理分类,胎儿型7例,其中荧光显像为全荧光型4例,部分荧光型3例;混合性胎儿上皮和胚胎上皮型1例,其荧光显像为部分荧光型。所有病灶经ICG分子荧光边界定界,切除肿瘤后,经荧光再测和病理检查,均获得了肿瘤R0切除。结论 ICG荧光显影技术在肝母细胞瘤中有较好的显影效果,显影类型与术前有无化疗有一定关系。ICG荧光显像在确定肿瘤边界和保证肿瘤R0切除具有一定优势和重要价值。但ICG荧光显像对深部微小肿瘤灶的识别和在肝硬化病例中的运用存在一定的局限性。更多还原

【Abstract】 Objective To explore the imagine characteristics of near-infrared technology guided by indolecyanine green( ICG) Tin hepatoblastoma( HB) and examine the value of this technique for identifying small lesions,defining tumor margin and exploring surgical navigation. Methods From March to June 2018,8 HB patients undergoing hepatectomy were recruited. ICG was injected intravenously at least 24 h before operation. Detecting liver small lesions,defining tumor margins and exploring surgical navigation were performed intraoperatively. After resection,the fluorescent characteristics of tumor was classified and the surgical margin detected and confirmed pathologically. Results There were 4 boys and 4 girls with an average age of 33( 5-132) months. Among them,one patient had tumor recurrence,another one received chemotherapy after biopsy,4 received chemotherapy without biopsy and 2 underwent primary hepatectomy. All tumors showed bright fluorescence and clear boundaries with normal liver tissues. Due to deep location( distance to liver surface > 1. 5 cm) and small lesion( 1. 0 cm) of recurrent tumor,the lesion was not found by observation,palpation and ICG fluorescent imaging. Until regular hepatectomy was performed,ICG identified recurrent lesions by splitting liver specimen. According to the classification of fluorescence,4 cases showed total fluorescence. Two underwent primary tumor resection,one received chemotherapy after biopsy and another one had recurrence with a history of hepatitis and liver mild sclerosis. Full fluorescence of tumor was accompanied by diffuse nodular hepatic imaging. Partial fluorescence was detected in another four patients with preoperative chemotherapy. Pathologic examination indicated that fluorescent image was total( n = 4),partial( n = 1) and mixed fetal and embryonic hepatoblastoma( n = 1). All tumor margins were negative and confirmed by ICG and pathology. Conclusion Intraoperative ICG fluorescent imaging for HB patients is both feasible and useful. And the type of fluorescent imaging is correlated with preoperative chemotherapy. This technique has the advantages identifying small viable lesions and confirming no remnant tumor after resection. However,ICG fluorescence imaging has some limitations for deep small tumor foci and liver cirrhosis.更多还原