作者： 张维富1,2，杨梓锋2，陈志良2,3，吕泽坚2，李勇1,2

单位：1.广东医科大学第一临床医学院，广东 湛江 524023；2.南方医科大学附属广东省人民医院（广东省医学科学院） 胃肠外科，广东 广州 510080；3.南方医科大学第十附属医院（东莞市人民医院） 胃肠外科，广东 东莞 523058

Authors: Zhang Weifu1,2, Yang Zifeng2, Chen Zhiliang2,3, Lyu Zejian2, Li Yong1,2

Unit:  1.The First Clinical Medical College, Guangdong Medical University, Zhan Jiang 524023, Guangdong, China；2.Department of Gastrointestinal Surgery, Guangdong Provincial People's Hospital Affiliated to Southern Medical University (Guangdong Academy of Medical Sciences), Guangzhou 510080, Guangdong, China；3.Department of Gastrointestinal Surgery, the Tenth Affiliated Hospital of Southern Medical University/Dongguan People's Hospital, Dongguan 523058, Guangdong, China

摘要：

目的 评估改良封装吲哚菁绿（indocyanine green，ICG）荧光标记肠脂垂用于腹腔镜结肠癌术中引导系膜层面解剖的可行性和有效性。方法 采用描述性病例系列研究方法，回顾性收集并分析2022年2月至4月在南方医科大学附属广东省人民医院（广东省医学科学院）胃肠外科接受改良封装ICG标记肠脂垂在腹腔镜结肠癌术中引导系膜解剖层面识别的患者临床资料。观察并记录患者临床信息、ICG用量、荧光肠脂垂显影率、荧光外溢率、围手术期及手术信息（包括手术时间、术中出血量、围手术期并发症发生情况）和术后住院天数等。结果 共9例患者被纳入研究，其中4例行腹腔镜辅助升结肠癌根治术，5例行腹腔镜辅助乙状结肠癌根治术。所有病例均在术中观察到目标区域的改良封装ICG标记肠脂垂荧光信号，显影率100%，且未发生额外的荧光泄漏和术中并发症，平均手术时间（184.4±52.6）min，中位出血量为20（20,75）ml，平均术后住院天数（6.0±1.6）d，术后全部患者顺利出院且术后30 d内未出现并发症。结论 改良封装ICG荧光标记肠脂垂在腹腔镜结肠癌根治术中可引导术者进入正确的解剖层面，避免相关副损伤，该辅助手段安全有效。

关键词： 吲哚菁绿；肠脂垂；腹腔镜；结肠癌根治术；解剖层面

Abstract：

Objective   To evaluate the feasibility and effectiveness of the modified encapsulated indocyanine green (ICG) fluorescent labeling of appendices epiploicae for guiding mesangial dissection during laparoscopic colon cancer surgery. Method  This is a descriptive case-series-study. Clinical data of patients who received modified encapsulated ICG-labeled appendices epiploicae in the Department of Gastrointestinal Surgery, Guangdong Provincial People's Hospital Affiliated to Southern Medical University (Guangdong Academy of Medical Sciences) for guiding mesangial anatomic identification during laparoscopic colon cancer surgery from February to April 2022 were retrospectively collected and analyzed. Clinical information, dosage of ICG, fluorescent appendices epiploicae imaging rate, fluorescence extravasation rate, perioperative period and surgical information (including operation time, intraoperative blood loss, perioperative complications) and postoperative hospitalization days of patients were observed and recorded. Result  A total of 9 patients were included in the study, of which 4 underwent laparoscopically assisted radical resection of ascending colon cancer and 5 underwent laparoscopically assisted radical resection of sigmoid cancer. In all cases, the modified encapsulated ICG-labeled appendices epiploicae in the target area were observed intraoperatively, with a development rate of 100%, and no additional fluorescence leakage or intraoperative complications occurred. The average operative time was (184.4±52.6) min, the median blood loss was 20 (20,75) ml, and the average postoperative hospital stay was (6.0±1.6) d. All patients were discharged successfully and no complications occurred within 30 d after surgery. Conclusion  The modified encapsulated ICG fluorescent labeling of appendices epiploicae can guide the operator into the correct anatomical level during laparoscopic radical resection of colon cancer and avoid related collateral damage. This auxiliary means is safe and effective.

Key Words:  Indocyanine green; Appendices epiploicae; Laparoscopy; Radical resection of colon cancer; Anatomical level

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