| Background.Liver cancer has now become one of the most common malignant tumors in China,and its morbidity and mortality rates are among the highest in the world.At present,the first choice for liver cancer patients is still surgical resection,among which curative resection plays a key role in patients’ long-term survival after surgery.However,the current 5-year survival rate of liver cancer patients after surgery is only18%,so it is especially important to increase the rate of curative resection of tumors.With the rise of medical visualization technology,research related to the visualization of intraoperative tumor tracking has become more in-depth,of which indocyanine green is one of the important representatives.Because of its fluorescent properties,it has made important breakthroughs in recent years in extrahepatic biliary tract identification,real-time intraoperative liver tumor localization and pre-cut line marking of resected liver segments,but it is still in the exploration stage.In this paper,we will discuss its clinical value in laparoscopic curative resection of hepatocellular carcinoma compared with regular laparoscopic hepatectomy in terms of surgical bleeding,operative time,hospital stay,duration of hepatic portal blocks,postoperative ALT and AST recovery time to preoperative levels,and resection margin condition.Objective.The purpose of this study was to compare the application of ICG fluorescence imaging technique in laparoscopic hepatectomy for performing navigation with traditional laparoscopic hepatectomy in terms of operative time,bleeding,hospital stay,resection margin condition,duration of hepatic portal blocks,and postoperative ALT and AST recovery time to preoperative levels,so as to evaluate the application of ICG fluorescence imaging technique in laparoscopic curative hepatectomy for hepatocellular carcinoma in terms of safety,effectiveness,etc.Materials and methods:Patients who underwent laparoscopic resection of hepatocellular carcinoma in our hospital from June 2018 to December 2022 and were pathologically confirmed as HCC after surgery were collected,and a total of 40 cases of intraoperative application of ICG fluorescence laparoscopy were collected to join the text group according to the inclusion and exclusion criteria,while a total of 72 patients who underwent conventional laparoscopic resection of hepatocellular carcinoma in the same period were randomly selected as the control group.Firstly,the medical records already enrolled in the group were compared for general data and observation indexes,including gender,age,number of tumors,size of tumor diameter,Child classification,score,whether combined with cirrhosis,etc.The observation indexes included operation duration,intraoperative bleeding,hospital stay,cutting edge condition,duration of hepatic portal blocks,postoperative ALT and AST recovery time to preoperative level,etc.Subsequently,the propensity of the data of the two groups was propensity score matching(the allocation ratio was 1:1adjacent matching),and the total number of cases included after matching was 74.There were 37 cases in the experimental group and 37 cases in the control group.After propensity score matching was performed,general information and observation indexes were compared again,and finally conclusions were drawn.Results:A total of 112 patients were included in this study,including 40 patients in the experimental group and 72 patients in the control group.The two groups of patients were successfully operated,preoperative general data of the two groups: gender: 30males(75.00%)and 10 females(25.00%)in the experimental group,55 males(76.39%)and 17 females(23.61%)in the control group,P > 0.05;age:(60.38 ± 10.48)years in the test group,(61.65 ± 10.18)years in the conventional group,P > 0.05;combined cirrhosis: 35 cases(87.50%)in the experimental group,56 cases(77.78%)in the control group,P > 0.05;maximum tumor diameter:(2.83 ± 1.92)cm in the test group,(3.05 ± 1.57)cm in the control group,P > 0.05;tumor number:(1.75 ± 0.38)in the test group,(1.13 ± 0.39)in the control group,P > 0.05.Child classification: 38 cases of class A in the test group,accounting for 95.00%,2 cases of class B,accounting for 5.00%;63 cases of class A in the control group,accounting for 87.50%,9 cases of class B,accounting for 12.50%,P > 0.05;Child score:(5.18 ± 0.50)points in the experimental group,(5.15 ± 0.49)points in the control group,and there was no statistical difference in the above data.Comparison of observation indicators of data between the two groups: hospital stay: test group(16.15 ± 3.59)d,control group(17.2± 3.47)d,P > 0.05;operation time: test group(3.62 ± 1.60)h,control group(3.70 ±1.46)h,P > 0.05;intraoperative blood loss: test group(203 ± 101.33)ml,control group(200.42 ± 99.72)ml,P > 0.05;postoperative ALT recovery preoperative level time: test group(5.68 ± 1.69)d,control group(5.89 ± 1.59)d,P > 0.05,the above two groups of data were not significantly different,but the duration of hepatic portal blocks: test group(18.45±25.35)min slightly less than the control group(23.70±20.70)min,P < 0.05,the difference was statistically significant;minimum resection margin: test group(1.10 ± 0.33)cm higher than the control group(0.82 ±0.32)cm,P < 0.05,the difference was statistically significant;Postoperative AST recovery time:(5.42 ± 1.32)d in test group was significantly shorter than(6.15 ± 1.68)d in control group,P < 0.05,and the difference had statistical significance.After propensity score matching,the differences between the experimental group and the control group were not statistically significant(P > 0.05)in terms of intraoperative bleeding,operative time,and hospital stay,but in the comparison of the resection margin situation(the shortest tumor resection margin ≥ 1 cm was defined as wide resection margin),the resection margin width in the experimental group(1.16 ± 0.32)cm was significantly higher than that in the control group(0.83 ± 0.28)cm,while the The duration of hepatic portal blocks in the experimental group(18.15±25.35)min was less than that in the control group(23.70±20.70)min,as well as the time to restore the preoperative level of AST in the experimental group(5.32±1.59)was less than that in the control group(6.54±1.48),and the difference was statistically significant(P<0.05).Conclusion::Compared with conventional laparoscopic resection of liver cancer,ICG fluorescence imaging technique effectively reduces the duration of hepatic portal block,shortens the postoperative liver function recovery time,and improves the safety of surgery;ICG fluorescence imaging technique is helpful for intraoperative real-time tumor navigation,liver section determination,and preservation of sufficiently wide resection margin,improving the radicality of surgery. |
