吲哚菁绿荧光实时导航在机器人辅助复杂性肾肿瘤肾部分切除术中的应用

目的 探讨应用吲哚菁绿（ICG）在达芬奇Xi机器人辅助下精准切除复杂性肾肿瘤中的有效性及安全性。方法 回顾性分析2021年6月至2021年12月于福建医科大学附属第一医院由同一术者在ICG荧光实时导航下通过达芬奇Xi机器人辅助对复杂性肾肿瘤行肾部分切除术的22例患者的临床资料。患者阻断肾动脉前2 min均经肘正中静脉注射ICG，剂量为0.25 mg/kg。术中在机器人荧光实时导航下定位肿瘤边界，精准切除肾肿瘤。收集并整理所有患者的基本信息以及围手术期的相关资料并进行统计分析。结果 共计纳入男性患者16例，女性患者6例，中位年龄53（34～72）岁，体重指数24.8（19.8～26.2）kg/m²。肾上极肿瘤10例（45%），肾中部肿瘤7例（32%），肾下极肿瘤5例（23%）。肿瘤长径为6.3（3.4～9.4）cm。肿瘤术前临床分期为T1aN0M0 2例（9%），T1bN0M0 18例（82%），T2aN0M0 2例（9%）。术前R.E.N.A.L.评分为8（7～11）分。22例患者手术均成功实施，无中转开放手术者，患者术中注射ICG无严重过敏症状发生，所有手术切缘未见阳性。中位手术时间为119（102～235）min，中位肾动脉阻断热缺血时间为20（18～29）min。术中中位失血量为60（40～300）mL，未输血。术后中位住院时间为6（4～9）d。术后随访时间内无严重并发症，未见肿瘤复发和转移。结论 在达芬奇Xi机器人引导下行ICG荧光显影术可实时区分复杂性肾肿瘤边界，辅助泌尿外科医师精准切除肿瘤，最大限度保留肾功能，该技术的临床应用安全有效。

Application of the indocyanine green fluorescence imaging technique in robot assisted laparoscopic partial nephrectomy for complicated renal tumors

Objective  To investigate efficiency and safety of indocyanine green (ICG) fluorescence imaging technique in robot assisted laparoscopic partial nephrectomy for complicated renal tumors.Methods  Between June 2021 and December 2021, clinical data of 22 patients with complicated renal tumors underwent Da Vinci robot-assisted partial nephrectomy under ICG fluorescence real-time navigation  at the first affiliated hospital of Fujian medical university by a single physician. ICG was injected 0.25 mg/kg through the median elbow vein 2 min before blocking renal artery. The ICG fluorescence real-time navigation was used for identifying the edge of tumor. The basic information and perioperative data of all patients were collected and analyzed statistically.Results  A total of 16 males and 6 females were included, with a median age of 53 (34～72) years and a body mass index of 24.8 (19.8～26.2) kg/m². There were 10 cases (45%) of tumors in the upper pole of the kidney, 7 cases (32%) in the middle of the kidney, and 5 cases (23%) in the lower pole of the kidney. The tumor diameter was 6.3 (3.4～9.4) cm. The preoperative clinical stages were T1aN0M0 in 2 cases (9%), TlbN0M0 in 18 cases (82%) and T2aN0M0 in 2 cases (9%). The preoperative R.E.N.A.L.score was 8 (7～11). All the 22 patients were successfully operated, and no patients were transferred to open, no severe allergic symptoms occurred in patients with intraoperative ICG injection, and no positive results were found in all surgical margins. The median operation time was 119 (102～235) min and the median renal artery occlusion heat ischemia time was 20 (18～29) min. The median intraoperative blood loss was about 60 (40～300) mL without transfusion. The median length of postoperative hospitalization was 6 (4～9) days. There were no serious complications and no tumor recurrence and metastasis during postoperative follow-up.Conclusions  The application of near-infrared IGC fluorescence imaging technology under the guidance of Da Vinci Xi robot has emerged as an effective and safe tool that may facilitate partial nephrectomy for complicated renal tumors．