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中华结直肠疾病电子杂志 ›› 2021, Vol. 10 ›› Issue (02) : 211 -215. doi: 10.3877/cma.j.issn.2095-3224.2021.02.016

所属专题: 经典病例 文献

病例报道

吲哚菁绿荧光造影辅助腹腔镜个体化侧方淋巴清扫策略治疗中低位直肠癌五例报告
杜瑞1, 周家杰1, 王峰1, 李东亮2, 佟贵繁1, 丁旭2, 张琪2, 王伟3, 汪刘华3, 汤东3, 王道荣3,()   
  1. 1. 116044 大连医科大学研究生院
    2. 225001 扬州大学研究生院
    3. 225001 扬州大学临床医学院 江苏省苏北人民医院胃肠外科 扬州大学-扬州市普通外科研究所 南京医科大学扬州临床医学院
  • 收稿日期:2020-08-31 出版日期:2021-04-25
  • 通信作者: 王道荣
  • 基金资助:
    江苏省重点病种规范化诊疗项目(BE2015664); 扬州市十三五科教强卫临床医学中心(省市共建项目No. XKC201801)

Indocyanine green-fluorescence imaging-assisted laparoscopic individualized lateral lymph node dissection strategy in the treatment for low-grade rectal cancer: Five cases report

Rui Du1, Jiajie Zhou1, Feng Wang1, Dongliang Li2, Guifan Tong1, Xu Ding2, Qi Zhang2, Wei Wang3, Liuhua Wang3, Dong Tang3, Daorong Wang3,()   

  1. 1. Graduate School, Dalian Medical University, Dalian 116044, China
    2. Graduate School, Medical College of Yangzhou University, Yangzhou 225001, China
    3. Medical College of Yangzhou University, Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, General Surgery Institute of Yangzhou-Yangzhou University, Yangzhou 225001, China
  • Received:2020-08-31 Published:2021-04-25
  • Corresponding author: Daorong Wang
引用本文:

杜瑞, 周家杰, 王峰, 李东亮, 佟贵繁, 丁旭, 张琪, 王伟, 汪刘华, 汤东, 王道荣. 吲哚菁绿荧光造影辅助腹腔镜个体化侧方淋巴清扫策略治疗中低位直肠癌五例报告[J/OL]. 中华结直肠疾病电子杂志, 2021, 10(02): 211-215.

Rui Du, Jiajie Zhou, Feng Wang, Dongliang Li, Guifan Tong, Xu Ding, Qi Zhang, Wei Wang, Liuhua Wang, Dong Tang, Daorong Wang. Indocyanine green-fluorescence imaging-assisted laparoscopic individualized lateral lymph node dissection strategy in the treatment for low-grade rectal cancer: Five cases report[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2021, 10(02): 211-215.

中低位直肠癌的侧方淋巴结清扫(LLND)是一个热点和难点,东西方的治疗策略也一直有很大的区别。由于LLND存在不确定的肿瘤学效果和并发症高发生率,如何将其变得个体化、简单化,成为近年来的研究热点之一。目前吲哚菁绿(ICG)已经广泛应用于检测各种类型恶性肿瘤中转移性淋巴结,然而国内少有采用吲哚菁绿荧光造影(ICG-FI)辅助腹腔镜行LLND的报道。本中心采用ICG-FI辅助腹腔镜对5例中低位直肠癌患者行选择性、个体化LLND,术中淋巴结的识别效果显著,清扫简单化,术后淋巴结检出率增加。

Lateral lymph node dissection (LLND) of low-grade rectal cancer is a hot and difficult point, and there has been a great difference in treatment strategies between the East and the West. Due to the uncertain oncology effect and high incidence of complications in LLND, how to make it individualized and simplified has become one of the research hotspots in recent years. At present, indocyanine green (ICG) has been widely used to detect metastatic lymph nodes in various types of malignant tumors. However, there are few reports of indocyanine green fluorescence contrast (ICG-FI)-assisted laparoscopic LLND in China. In our center, ICG-FI-assisted laparoscopy was used to identify lymph nodes in 5 patients with low-grade rectal cancer by selective and individualized LLND, the recognition effect of lymph nodes during operation was significant, which simplified the dissection and increased the detection rate of lymph nodes after operation.

图1 肠系膜下动脉区域的淋巴结显影及清扫。1A:第253组淋巴结通过ICG显影;1B:ICG显影辅助下,清扫第253组淋巴结
图2 肿瘤下缘注射部位及显影。2A:ICG注射在肿瘤下缘部位;2B:切换为ICG显影模式后,肿瘤本身及周围的显影效果
图3 侧方淋巴结显影及清扫。3A:打开输尿管表面腹膜,将其向内侧牵拉,暴露清扫区域;3B:ICG显影辅助下,清扫髂内血管近端及闭孔区域;3C:ICG显影辅助下,清扫髂内血管远端区域
图4 清扫后境界(No.293、No.283、No.263D、No.263P)(4A)及术后标本(4B)
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