吲哚菁绿荧光影像技术对原发性肝癌手术治疗的指导价值以及近期预后分析

doi:10.16139/j.1007-9610.2025.04.06

摘要/Abstract

摘要：

目的：探讨吲哚菁绿（ICG）荧光影像技术对原发性肝癌肝切除术的指导价值与对病人近期预后的分析。方法：回顾性采集了上海交通大学医学院附属第一人民医院肝胆外科2018年6月至2021年6月行肝癌切除术的166例原发性肝癌病人病例的临床资料，并按照病人术中是否使用ICG荧光影像技术分为ICG组（72例）和非ICG组（94例）。比较两组术前、术中、术后资料，并对ICG组病人肿瘤病灶的ICG荧光图像进行分析。结果：ICG荧光强度与肿瘤病理组织学、分化程度、肝硬化与否相关。肝细胞癌多显示为部分荧光，而肝内胆管癌多显示为环状荧光。高分化肿瘤多为完全荧光（7/11），中分化肿瘤多为部分荧光（28/51），低分化肿瘤多为环形荧光（7/10）。肝硬化病人多为部分荧光（18/35）或完全荧光（13/35）。ICG组血白蛋白水平术后第1天（34.6 g/L比31.4 g/L）及第3天（32.4 g/L比31.2 g/L）高于非ICG组（P<0.001），而手术时间（170 min比210 min）、肝门阻断率（9.7%比33.0%）、术中出血量（400 mL比430 mL）、术后住院时间（10 d比14 d）、术后近期并发症发生率（4.2%比20.2%）明显低于非ICG组（P<0.05）。结论：ICG荧光强度与原发性肝癌肿瘤病理组织学、分化程度、肝硬化与否相关。ICG荧光影像技术合理应用减少手术时间，且有利于提高病人近期预后，加速病人术后的康复。

关键词: 原发性肝癌, 吲哚菁绿, 荧光影像, 肝切除术

Abstract:

Objective To explore the efficiency of indocyanine green (ICG) fluorescence imaging-guided hepatectomy and its short-term prognosis in patients with primary liver carcinoma. Methods Retrospective analysis was conducted on 166 patients diagnosed with primary liver carcinoma and admitted to the Department of Hepatobiliary Surgery of Shanghai General Hospital affiliated to Shanghai Jiao Tong University School of Medicine from June 2018 to June 2021. Patients were categorized into ICG group (n=72) and non-ICG group (n=94) based on the utilization of ICG during surgery. Moreover, the clinical information of preoperation, intraoperation, and postoperation were collected and compared between the two groups. ICG fluorescence images of the lesions in the ICG group were recorded for analysis. Results ICG fluorescence intensity is associated with the histopathology, differentiation grade of primary liver cancer, and the presence of liver cirrhosis. Hepatocellular carcinoma lesions predominantly displayed partial fluorescence, while intrahepatic cholangiocarcinoma lesions showed circular fluorescence. Well differentiated tumors exhibited complete fluorescence (7/11), moderately differentiated tumors demonstrated partial fluorescence (28/51), and poorly differentiated tumors displayed circular fluorescence (7/10). Most patients with liver cirrhosis exhibited partial fluorescence (18/35) or complete fluorescence (13/35).Compared to the non-ICG group, the ICG group demonstrated higher serum albumin levels on the first (34.6 g/L vs. 31.4 g/L) and the third postoperative days (32.4 g/L vs. 31.2 g/L)(P<0.001). Conversely, the ICG group showed shorter operation time (170 min vs. 210 min), lower rate of intraoperative hepatic portal blockade (9.7% vs. 33.0%), less intraoperative blood loss (400 mL vs. 430 mL), shorter postoperative hospital stay (10 d vs. 14 d), and lower incidence of short-term postoperative complications (4.2% vs. 20.2%) (P<0.05) compared to the non-ICG group. Conclusions ICG fluorescence intensity is associated with the histopathology, differentiation grade of primary liver cancer, and the presence of liver cirrhosis.The judicious application of ICG fluorescence imaging technology alongside surgical techniques holds promise for improving short-term prognosis and expediting the postoperative recovery.

Key words: Primary liver carcinoma, Indocyanine green(ICG), Fluorescence image, Hepatectomy

中图分类号:

R735.7

黄文欣, 何启宁, 戚德彬, 曹梓超, 姜艳芝, 王普森, 阙伟涛, 钟林. 吲哚菁绿荧光影像技术对原发性肝癌手术治疗的指导价值以及近期预后分析[J]. 外科理论与实践, 2025, 30(04): 325-331.

HUANG Wenxin, HE Qining, Qi Debin, Cao Zichao, JIANG Yanzhi, WANG Pusen, QUE Weitao, ZHONG Lin. Assessment of indocyanine green fluorescence imaging in hepatectomy for primary liver carcinoma: short-term prognostic analysis[J]. Journal of Surgery Concepts & Practice, 2025, 30(04): 325-331.

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Item	ICG group （n=72）	non-ICG group （n=94）	t/χ²/Z value	P value
Age(years)	61.9±12.3	58.8±11.2	1.703	0.091
Gender
Female	17（23.6）	30（31.9）	1.385	0.239
Male	55（76.4）	64（68.1）
HBsAg
Negative	34（47.2）	33（35.1）	2.486	0.115
Positive	38（52.8）	61（64.9）
Preoperative examination
Leukocyte（×10⁹）	5.5（4.2,7.7）	5.47（4.6,6.4）	-0.370	0.711
ALT（U/L）	30.0（19.4,44.4）	33.3（26.0,39.3）	-0.870	0.384
AST（U/L）	33.6（22.4,50.5）	35.7（26.8,41.7）	-0.298	0.766
AFP（μg/L）	120.3（31.6,333.8）	98.1（25.4,359.1）	-0.355	0.722
Cirrhosis
Negative	37（51.4）	46（48.9）	0.098	0.754
Positive	35（48.6）	48（51.1）
Child Pugh
A	68（94.4）	89（94.7）	0.004	0.947
B	4（5.6）	5（5.3）
Tumor size (≥5 cm)
Negative	41（56.9）	56（59.6）	0.116	0.733
Positive	31（43.1）	38（40.4）
Number of tumors	1（1，1）	1（1，1）	-0.74	0.941
Degree of differentiation
High	11（15.3）	9（9.6）	1.290	0.525
Moderate	51（70.8）	70（74.5）
Low	10（13.9）	15（16.0）
Tumor thrombus
Negative	66（91.7）	90（95.7）	1.198	0.274
Positive	6（8.3）	4（4.3）
Tumor type
Hepatocellular carcinoma	48（66.7）	67（71.3）	0.422	0.810
Intrahepatic bile duct carcinoma	19（26.4）	21（22.3）
Mixed liver carcinoma	5（6.9）	6（6.4）

Item	Non-fluorescent （n=3）	Partially-fluorescent （n=32）	Circular-fluorescence （n=18）	Completely-fluorescent （n=19）	χ² value	P value
HBs Ag+	1（33.3）	15（46.9）	11（61.1）	11（57.9）	1.604	0.659
HCV Ag+	0	1（3.1）	0	1（5.3）	1.049	0.789
Cirrhosis	0	18（56.3）	4（22.2）	13（68.4）	17.875	<0.001
Tumor type
Hepatocellular carcinoma	0	25（78.1）	8（44.4）	15（78.9）	18.112	0.006
Intrahepatic bile duct carcinoma	3（100）	4（12.5）	9（50.0）	3（15.8）
Mixed liver carcinoma	0	3（9.4）	1（5.6）	1（5.3）
Degree of differentiation
High	1（33.3）	2（6.3）	1（5.6）	7（36.8）	24.746	<0.001
Moderate	1（33.3）	28（87.5）	10（55.6）	12（63.2）
Low	1（33.3）	2（6.3）	7（38.9）	0

Item	ICG group （n=72）	non-ICG group （n=94）	χ²/Z value	P value
Operation time	170（140,200）	210（166,348）	-4.416	<0.001
Portal blockade rate	7（9.7）	31（33.0）	12.493	<0.001
Intraoperative blood loss	400（150,587.5）	430（325,752.5）	-2.053	0.040
Intraoperative blood transfusion rate	14（19.4）	21（22.3）	0.206	0.650

Item	ICG group（n=72）	non-ICG group (n=94）	χ²/Z value	P value
Surgical margin negative rate	69（95.8％）	86（91.5％）	1.243	0.265
Postoperative hospital stay	10（8,12）	14（10,21）	-4.317	<0.001
Number of painkillers used	1（1,1）	2（1,2）	-6.189	<0.001
Postoperative antibiotic use times	1（1,1）	2（1,2）	-5.738	<0.001
Drainage on the first day after surgery	200（80,300）	230（180,282.5）	-1.677	0.094
The incidence of postoperative complications in the short term	3（4.2）	19（20.2）	9.131	0.003
Highest body temperature before discharge	38(37.4,38.5)	38.1(37.8,38.4)	-0.782	0.434
Blood biochemistry on the first day after surgery
Leukocyte（×10⁹）	11.6(8.5,16.0)	14.3(12.5,16.3)	-3.680	<0.001
ALT（U/L）	292.0(116.3,541.6)	296.3(201.0,443.8)	-1.209	0.227
AST（U/L）	304.0(146.6,616.4)	326.8(236.6,459.9)	-0.727	0.467
TBil（μmol/L）	23.5（18.1,29.7）	27.0(18.2,33.6)	-1.060	0.289
Albumin（g/L）	34.6（30.4,37.0）	31.4（29.3,33.6）	-3.611	<0.001
Blood biochemistry on the third day after surgery
Leukocyte（×10⁹）	8.7(7.2,10.5)	11.6(9.5,13.0)	-4.297	<0.001
ALT（U/L）	180.8(100.5,504.5)	193.4(143,265.3)	-1.267	0.205
AST（U/L）	94.9(55.8,270.2)	124.5(84.2,168.5)	-2.042	0.041
TBil（μmol/L）	22.3（17.7,25.7）	28.6(18.7,41.7)	-2.048	0.041
Albumin（g/L）	32.4（31.1,35.9）	31.2（29.6,33.2）	-5.043	<0.001
Blood biochemistry on the seventh day after surgery
Leukocyte（×10⁹）	8.8(6.2,10.0)	7.7(6.4,9.4)	-1.069	0.285
ALT（U/L）	77.4(42.1,172.1)	75.5(59.8,94.1)	-0.293	0.770
AST（U/L）	39.9(25.9,72.6)	45.8(37.7,56.8)	-0.538	0.591
TBil（μmol/L）	19.6(15.8,23.9)	22.3(14.9,32.9)	-1.396	0.163
Albumin（g/L）	34.4(31.0,36.5)	32.8(30.9,34.9)	-1.785	0.074