Application Of Indocyanine Green Fluorescence Imaging In Laparoscopic Anatomical Hemihepatectomy

Objective:At present,hepatectomy is the most effective method to treat liver cancer,and with the rapid development of medical technology,anatomical hepatectomy is widely used in clinical.The near-infrared fluorescence imaging technology based on indocyanine green(ICG)is still in the exploratory stage as a new navigation method in laparoscopic anatomical hepatectomy.Therefore,the purpose of this study is to compare the results of laparoscopic anatomical hepatectomy performed by indocyanine green staining and other methods,such as hepatic vein approach and ischemia line,and the therapeutic effect in the treatment of liver cancer,Therefore,to evaluate the application value of indocyanine green in laparoscopic anatomical hepatectomy is helpful to select a more appropriate operation mode and achieve better therapeutic effect.Methods:The clinical data of 37 patients who underwent hepatectomy for primary liver cancer from June 2018 to October 2019 were analyzed.Among them,16 cases of laparoscopic anatomical hepatectomy guided by near-infrared fluorescence of indocyanine green were used,i.e.positive staining and negative staining(fluorescein group),21 cases of laparoscopic anatomical hepatectomy guided by non fluorescence were used,i.e.along the surface of the liver,along the hepatic vein,controlling the target hepatic pedicle in advance,and along the ischemic interface(control group).Finally,14 patients in figfi group and 19 patients in control group were included in the data analysis.The indexes of the two groups were observed:(1)preoperative general conditions:age,sex,preoperative liver function level,tumor size.Child-Pugh grade,hepatitis situation and alpha fetoprotein(AFP),etc;(2)Intraoperative conditions:surgical resection scope,staining method,operation time,intraoperative blood loss and blood transfusion;(3)postoperative conditions:liver function level such as total bilirubin,aspartate aminotransferase(AST)and alanine aminotransferase(ALT)on the first,third and sixth days,coagulation index,maximum postoperative temperature,postoperative pathology type,postoperative complications and postoperative hospital stay;(4)Prognosis:all patients were followed up regularly,and the recurrence rate of 1,2,3 months after operation was counted.Results:There was no death in the two groups.There was no significant difference in age,gender,liver function index,tumor size and child Pugh grade between the two groups(P>0.05).The operation time of figfi group was not significantly different from that of the control group(P>0.05),but the time of hepatic portal occlusion was significantly shorter than that of the control group(P<0.05).The level of total bilirubin,alanine aminotransferase and aspartate aminotransferase in the first,third and sixth day after operation in the two groups were better than those in the control group.The difference of ALT and AST in the first and third day after operation was statistically significant(P<0.05).The highest body temperature of figfi group was lower than that of control group(P<0.05).There was no significant difference in the length of stay between the two groups.There was no significant difference in postoperative complications between the two groups(P>0.05).The drainage time in figfi group was shorter than that in control group,but there was no significant difference(P>0.05).Conclusion:1.The near infrared fluorescence navigation technology based on ICG can guide laparoscopic anatomical hepatectomy to treat liver cancer in real time,which is helpful to improve the accuracy of regular hepatectomy,and has a good application prospect.Compared with the traditional method of anatomical hepatectomy,fluorescence guided anatomical hepatectomy can clearly define the scope of hepatectomy,which can be used as an important auxiliary means of anatomical hepatectomy.2.The technique of fluorescence navigation can make the definition of the plane of liver transection more simple,the amount of bleeding is less,but the operation time is longer.The prolongation of operation time did not increase the incidence of postoperative complications.3.The advantages of fluorescence navigation technology are mainly reflected in the operation,but the advantages are not obvious after the operation.4.Compared with the control group,the postoperative body temperature of the patients in the fluorescence guided laparoscopic anatomical hepatectomy group was lower,considering that the residual dead liver was less,and the postoperative absorption heat of the patients was reduced.