切换至 "中华医学电子期刊资源库"

中华普通外科学文献(电子版) ›› 2023, Vol. 17 ›› Issue (03) : 161 -168. doi: 10.3877/cma.j.issn.1674-0793.2023.03.001

专家共识

吲哚菁绿近红外光成像技术在腹腔镜胃癌根治术中应用中国专家共识(2023版)
中华医学会外科学分会胃肠外科学组   
  • 出版日期:2023-06-01
  • 基金资助:
    2018年度福建省科技创新联合资金项目(2018Y9041)

Chinese expert consensus on the application of indocyanine green near-infrared imaging in laparoscopic radical gastrectomy for gastric cancer (2023 edition)

Chinese Society of Gastrointestinal Surgery, Chinese Society of Surgery, Chinese Medical Association   

  • Published:2023-06-01
引用本文:

中华医学会外科学分会胃肠外科学组. 吲哚菁绿近红外光成像技术在腹腔镜胃癌根治术中应用中国专家共识(2023版)[J]. 中华普通外科学文献(电子版), 2023, 17(03): 161-168.

Chinese Society of Gastrointestinal Surgery, Chinese Society of Surgery, Chinese Medical Association. Chinese expert consensus on the application of indocyanine green near-infrared imaging in laparoscopic radical gastrectomy for gastric cancer (2023 edition)[J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(03): 161-168.

自1994年日本Kitano等[1]首次报道腹腔镜远端胃癌根治术以来,经过20余年的发展,腹腔镜胃癌根治术在临床上得到广泛的应用[2-6]。近年来,随着腹腔镜器械的进步和技术的发展,腹腔镜胃癌手术亦逐渐迈向精准医学时代。因此,胃肠外科医师仍在不断探索在腹腔镜下进行精确又简便地肿瘤定位与淋巴结导航方式,实现系统、充分的淋巴结清扫,以及安全保证吻合口血运[7-10]

图1 吲哚菁绿近红外光成像技术原理
图2 吲哚菁绿注射示例图片 A为吲哚菁绿黏膜下注射部位;B为吲哚菁绿黏膜下注射效果;C为吲哚菁绿浆膜下注射部位;D为吲哚菁绿浆膜下注射效果
图3 胃癌根治术中浆膜下注射吲哚菁绿建议注射点示意图
表1 吲哚菁绿推荐注射方式
图4 利用吲哚菁绿示踪协助术中肿瘤的定位
图5 吲哚菁绿近红外光成像对淋巴结的显示 A为幽门下区淋巴结的吲哚菁绿荧光显影;B、C为胰腺上缘淋巴结的吲哚菁绿荧光显影;D为脾门淋巴结的吲哚菁绿荧光显影;E、F为清扫后残留淋巴结的吲哚菁绿荧光显影
图6 吲哚菁绿近红外光成像技术在吻合口和脏器血供评估的应用 A、B为利用吲哚菁绿荧光成像评估三角吻合后吻合口的血供;C、D为利用吲哚菁绿荧光成像评估脾上极动脉损伤后的脾脏血供
图7 术中利用吲哚菁绿近红外光成像技术分辨不同的淋巴结和胰腺组织 A-C为不同的淋巴结吲哚菁绿荧光显影;D-F为胰腺吲哚菁绿荧光显影
[1]
Kitano S, Iso Y, Moriyama M, et al. Laparoscopy-assisted BillrothI gastrectomy[J]. Surg Laparos Endosc, 1994, 4(2): 146-148.
[2]
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.
[3]
Yu J, Huang C, Sun Y, et al. Effect of laparoscopic vs open distal gastrectomy on 3-year disease-free survival in patients with locally advanced gastric cancer: The CLASS-01 randomized clinical trial[J]. JAMA, 2019, 321(20): 1983-1992.
[4]
Kim HH, Han SU, Kim MC, et al. Effect of laparoscopic distal gastrectomy vs open distal gastrectomy on long-term survival among patients with stage i gastric cancer: the KLASS-01 randomized clinical trial[J]. JAMA Oncol, 2019, 5(4): 506-513.
[5]
Hyung WJ, Yang HK, Park YK, et al. Long-term outcomes of laparoscopic distal gastrectomy for locally advanced gastric cancer: the KLASS-02-RCT randomized clinical trial[J]. J Clin Oncol, 2020, 38(28): 3304-3313.
[6]
Katai H, Mizusawa J, Katayama H, et al. Survival outcomes after laparoscopy-assisted distal gastrectomy versus open distal gastrectomy with nodal dissection for clinical stage IA or IB gastric cancer (JCOG0912): A multicentre, non-inferiority, phase 3 randomised controlled trial[J]. Lancet Gastroenterol Hepatol, 2020, 5(2): 142-151.
[7]
Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition)[J]. Gastric Cancer, 2021, 24(1): 1-21.
[8]
中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会胃癌临床诊疗指南(2021版)[J]. 中华医学杂志, 2022, 102(16): 1169-1189.
[9]
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)[J]. 中华消化外科杂志, 2016, 15(9): 851-857.
[10]
Wang FH, Zhang XT, Li YF, et al. The Chinese Society of Clinical Oncology (CSCO): clinical guidelines for the diagnosis and treatment of gastric cancer, 2021[J]. Cancer Commun (Lond), 2021, 41(8): 747-795.
[11]
Guo J, Yang H, Wang S, et al. Comparison of sentinel lymph node biopsy guided by indocyanine green, blue dye, and their combination in breast cancer patients: A prospective cohort study[J]. World J Surg Oncol, 2017, 15(1): 196.
[12]
Gilmore DM, Khullar OV, Jaklitsch MT, et al. Identification of metastatic nodal disease in a phase 1 dose-escalation trial of intraoperative sentinel lymph node mapping in non-small cell lung cancer using near-infrared imaging[J]. J Thorac Cardiovasc Surg, 2013, 146(3): 562-570.
[13]
Valente SA, Al-Hilli Z, Radford DM, et al. Near infrared fluorescent lymph node mapping with indocyanine green in breast cancer patients: A prospective trial[J]. J Am Coll Surg, 2019, 228(4): 672-678.
[14]
Yamashita S, Tokuishi K, Anami K, et al. Video-assisted thoracoscopic indocyanine green fluorescence imaging system shows sentinel lymph nodes in non-small-cell lung cancer[J]. J Thorac Cardiovasc Surg, 2011, 141(1): 141-144.
[15]
郭文斌, 高伟, 刘金涛, 等. 吲哚菁绿荧光导航技术在乳腺癌前哨淋巴结活检中的应用[J]. 中国普通外科杂志, 2015, 24(5): 658-662.
[16]
陈涵, 叶玉坤, 韩开宝, 等. 吲哚菁绿近红外光成像系统在非小细胞肺癌术中探寻前哨淋巴结的临床应用研究[J/CD]. 中华临床医师杂志(电子版), 2013, 7(23): 10599-10603.
[17]
Yano K, Nimura H, Mitsumori N, et al. The efficiency of micrometastasis by sentinel node navigation surgery using indocyanine green and infrared ray laparoscopy system for gastric cancer[J]. Gastric Cancer, 2012, 15(3): 287-291.
[18]
He M, Jiang Z, Wang C, et al. Diagnostic value of near-infrared or fluorescent indocyanine green guided sentinel lymph node mapping in gastric cancer: A systematic review and meta-analysis [J]. J Surg Oncol, 2018, 118(8): 1243-1256.
[19]
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.
[20]
Jung MK, Cho M, Roh CK, et al. Assessment of diagnostic value of fluorescent lymphography-guided lymphadenectomy for gastric cancer[J]. Gastric Cancer, 2021, 24(2): 515-525.
[21]
魏猛, 陈成, 王立梅, 等. 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[J]. 腹腔镜外科杂志, 2019, 24(3): 185-192.
[22]
黄昌明, 钟情, 陈起跃. 吲哚菁绿示踪淋巴结清扫在胃癌根治术中应用及研究进展[J]. 中国实用外科杂志, 2021, 41(3): 332-336.
[23]
Diana M, Agnus V, Halvax P, et al. Intraoperative fluorescencebased enhanced reality laparoscopic real-time imaging to assess bowel perfusion at the anastomotic site in an experimental model[J]. Br J Surg, 2015, 102(2): e169-e176.
[24]
Zehetner J, Demeester SR, Alicuben ET, et al. Intraoperative assessment of perfusion of the gastric graft and correlation with anastomotic leaks after esophagectomy[J]. Ann Surg, 2015, 262 (1): 74-78.
[25]
Frattini F, Lavazza M, Mangano A, et al. Indocyanine greenenhanced fluorescence in laparoscopic sleeve gastrectomy[J]. Obes Surg, 2015, 25(5): 949-950.
[26]
中华医学会外科学分会胃肠外科学组. 吲哚菁绿近红外光成像在腹腔镜胃癌根治术中应用中国专家共识(2019版) [J]. 中国实用外科杂志, 2020, 40(2):139-144.
[27]
Landsman ML, Kwant G, Mook GA, et al. Light-absorbing properties, stability, and spectral stabilization of indocyanine green[J]. J Appl Physiol, 1976, 40(4): 575-583.
[28]
Alander JT, Kaartinen I, Laakso A, et al. A review of indocyanine green fluorescent imaging in surgery[J]. Int J Biomed Imaging, 2012, 2012: 940585.
[29]
Schaafsma BE, Mieog JS, Hutteman M, et al. The clinical use of indocyanine green as a near-infrared fluorescent contrast agent for image-guided oncologic surgery[J]. J Surg Oncol, 2011, 104(3): 323-332.
[30]
Schols RM, Bouvy ND, Van Dam RM, et al. Advanced intraoperative imaging methods for laparoscopic anatomy navigation: An overview[J]. Surg Endosc, 2013, 27(6): 1851-1859.
[31]
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.
[32]
Liu M, Xing J, Xu K, et al. Application of near-infrared fluorescence imaging with indocyanine green in totally laparoscopic distal gastrectomy[J]. J Gastric Cancer, 2020, 20(3): 290-299.
[33]
Roh CK, Choi S, Seo WJ, et al. Indocyanine green fluorescence lymphography during gastrectomy after initial endoscopic submucosal dissection for early gastric cancer[J]. Br J Surg, 2020, 107(6): 712-719.
[34]
Chen QY, Xie JW, Zhong Q, et al. Safety and efficacy of indocyanine green tracer-guided lymph node dissection during laparoscopic radical gastrectomy in patients with gastric cancer: A randomized clinical trial[J]. JAMA Surg, 2020, 155(4): 300-311.
[35]
Chen QY, Zhong Q, Li P, et al. Comparison of submucosal and subserosal approaches toward optimized indocyanine green tracer-guided laparoscopic lymphadenectomy for patients with gastric cancer (FUGES-019): A randomized controlled trial[J]. BMC Med, 2021, 19(1): 276.
[36]
Park SH, Lee HJ, Park JH, et al. Clinical significance of intraoperative gastroscopy for tumor localization in totally laparoscopic partial gastrectomy[J]. J Gastrointest Surg, 2021, 25(5): 1134-1146.
[37]
Ushimaru Y, Omori T, Fujiwara Y, et al. The feasibility and safety of preoperative fluorescence marking with indocyanine green (ICG) in laparoscopic gastrectomy for gastric cancer[J]. J Gastrointest Surg, 2019, 23(3): 468-476.
[38]
Kwon IG, Son T, Kim HI, et al. Fluorescent lymphography guided lymphadenectomy during robotic radical gastrectomy for gastric cancer[J]. JAMA Surg, 2019, 154(2): 150-158.
[39]
刘茂兴, 邢加迪, 徐凯, 等. 吲哚菁绿荧光成像在全腹腔镜远端胃癌根治术中的应用[J]. 中国肿瘤临床, 2020, 47(5): 231-235.
[40]
宋武, 何裕隆. 早期胃癌淋巴结转移特点、规律和意义[J]. 中国实用外科杂志, 2019, 39(5): 444-447.
[41]
梁寒, 张李. 早期胃癌治疗方式合理选择:争议与共识[J].中国实用外科杂志, 2019, 39(5): 424-427.
[42]
Kim DW, Jeong B, Shin IH, et al. Sentinel node navigation surgery using near-infrared indocyanine green fluorescence in early gastric cancer[J]. Surg Endosc, 2019, 33(4): 1235-1243.
[43]
Shoji Y, Kumagai K, Kamiya S, et al. Prospective feasibility study for single-tracer sentinel node mapping by ICG (indocyanine green) fluorescence and OSNA (one-step nucleic acid amplification) assay in laparoscopic gastric cancer surgery[J]. Gastric Cancer, 2019, 22(4): 873-880.
[44]
Kim YW, Min JS, Yoon HM, et al. Laparoscopic sentinel node navigation surgery for stomach preservation in patients with early gastric cancer: A randomized clinical trial[J]. J Clin Oncol, 2022, 40(21): 2342-2351.
[45]
An JY, Min JS, Hur H, et al. Laparoscopic sentinel node navigation surgery versus laparoscopic gastrectomy with lymph node dissection for early gastric cancer: short-term outcomes of a multicentre randomized controlled trial (SENORITA)[J]. Br J Surg, 2020, 107(11): 1429-1439.
[46]
Huang CM, Lin JX, Zheng CH, et al. Prognostic impact of dissected lymph node count on patients with node-negative gastric cancer[J]. World J Gastroenterol, 2009, 15(31): 3926-3930.
[47]
Smith DD, Schwarz RR, Schwarz RE. Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: data from a large US-population database[J]. J Clin Oncol, 2005, 23(28): 7114-7124.
[48]
Son T, Hyung WJ, Lee JH, et al. Clinical implication of an insufficient number of examined lymph nodes after curative resection for gastric cancer[J]. Cancer, 2012, 118(19): 4687-4693.
[49]
Seevaratnam R, Bocicariu A, Cardoso R, et al. A meta-analysis of D1 versus D2 lymph node dissection[J]. Gastric Cancer, 2012, 15(1): 60-69.
[50]
Zhong Q, Chen QY, Huang XB, et al. Clinical implications of indocyanine green fluorescence imaging-guided laparoscopic lymphadenectomy for patients with gastric cancer: A cohort study from two randomized, controlled trials using individual patient data[J]. Int J Surg, 2021, 94: 106120.
[51]
Huang ZN, Su Y, Qiu WW, et al. Assessment of indocyanine green tracer-guided lymphadenectomy in laparoscopic gastrectomy after neoadjuvant chemotherapy for locally advanced gastric cancer: results from a multicenter analysis based on propensity matching[J]. Gastric Cancer, 2021, 24(6): 1355-1364.
[52]
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, 2019, 29(4): 476-483.
[53]
姚宏伟, 徐威, 张忠涛. 近红外荧光腹腔镜成像技术在直肠吻合口血运评估中的应用[J]. 中国实用外科杂志, 2019, 39(7): 744-745, 750.
[54]
Mori M, Shuto K, Hirano A, et al. A novel parameter identified using indocyanine green fluorescence angiography may contribute to predicting anastomotic leakage in gastric cancer surger[J]. World J Surg, 2020, 44(8): 2699-2708.
[55]
Lee JH, Son T, Chung YE, et al. Real-time identification of aberrant left hepatic arterial territories using near-infrared fluorescence with indocyanine green during gastrectomy for gastric cancer[J]. Surg Endosc, 2021, 35(5): 2389-2397.
[56]
Kusano M, Tajima Y, Yamazaki K, et al. Sentinel node mapping guided by indocyanine green fluorescence imaging: A new method for sentinel node navigation surgery in gastrointestinal cancer[J]. Dig Surg, 2008, 25(2): 103-108.
[57]
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.
[58]
Kitagawa Y, Takeuchi H, Takagi Y, et al. Sentinel node mapping for gastric cancer: A prospective multicenter trial in Japan[J]. J Clin Oncol, 2013, 31(29): 3704-3710.
[59]
Miyashiro I, Hiratsuka M, Sasako M, et al. High false-negative proportion of intraoperative histological examination as a serious problem for clinical application of sentinel node biopsy for early gastric cancer: final results of the Japan Clinical Oncology Group multicenter trial JCOG0302[J]. Gastric Cancer, 2014, 17(2): 316-323.
No related articles found!
阅读次数
全文


摘要