吲哚菁绿近红外光成像示踪技术应用于达芬奇机器人胃癌根治术中D2淋巴结清扫的安全性和有效性
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南京中医药大学附属医院普外科,江苏 南京 210029

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R735.2

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江苏省医学重点学科(ZDXK202251);江苏省中医药领军人才培养项目(SLJ0311)


Safety and efficacy of indocyanine green near ⁃ infrared fluorescence imaging tracer technology in the application of D2 lymph node dissection in da Vinci robotic gastrectomy
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Department of General Surgery,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029 ,China

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    摘要:

    目的:探讨在达芬奇机器人胃癌根治术中应用吲哚菁绿(indocyanine green,ICG)近红外光成像示踪技术引导D2淋巴结清扫的安全性和有效性。方法:回顾性纳入2021年1月—2024年1月在南京中医药大学附属医院普外科行达芬奇机器人胃癌根治术的患者,其中60例术中采用ICG荧光导航进行淋巴结清扫(ICG组),117例进行常规淋巴结清扫(非ICG组),通过倾向性评分匹配(1∶1)平衡基线特征。比较两组淋巴结清扫数量、手术相关指标、术后并发症发生率、住院时间及术后康复数据。结果:匹配后ICG组和非ICG组各60例,两组的年龄、性别、体重指数、营养评分、肿瘤直径、肿瘤部位、分化程度、脉管侵犯、Lauren分型均衡可比(P均>0.05)。所有患者均完成规定范围的淋巴结清扫,术后无荧光淋巴结残留。ICG组淋巴结平均清扫数量为(33.73±12.66)枚,显著高于非ICG组(26.15±6.31)枚(P < 0.05);但两组术后病理检出的阳性淋巴结数量差异无统计学意义[1(0,6)枚 vs. 0(0,4)枚,P > 0.05)。ICG组D1和D2区域的淋巴结清扫数量均显著高于非ICG组(P均<0.05);且在3、 4d、6、7、8a、12a站淋中巴结清扫中显示出优势。两组的手术时间、术中出血量、术后住院时间、术后并发症发生率及术后第 3 天C反应蛋白(C-reactive protein,CRP)、白细胞计数(white blood cell,WBC)、白蛋白(albumin,Alb)、天门冬氨酸氨基转移酶 (aspartate aminotransferase,AST)/丙氨酸氨基转移酶(alanine aminotransferase,ALT)差异均无统计学意义(P均>0.05);而ICG 组的通气时间短于非ICG组,差异有统计学意义(P < 0.05)。结论:ICG近红外光成像示踪技术在机器人胃癌根治术中的应用能够提高淋巴结清扫的精确性和彻底性,且不影响围手术期安全性。

    Abstract:

    Objective:This study aims to explore the safety and efficacy of utilizing indocyanine green near -infrared(ICG -NIR) fluorescence imaging to guide lymph node(LN)dissection during Da Vinci robotic gastrectomy(RG). Methods:The patients who underwent RG at the General Surgery Department of Affiliated Hospital of Nanjing University of Chinese Medicine from January 2021 to January 2024 were retrospectively analyzed. Among them,60 patients underwent ICG fluorescence navigation - guided lymphadenectomy(ICG group),while 117 received conventional LN dissection(non-ICG group). Propensity score matching(1∶1)was performed to balance baseline characteristics. The number of retrieved LNs,surgical outcomes,postoperative complications,hospital stay,and recovery data were compared between two groups. Results:After matching,each group comprised 60 patients with comparable baseline characteristics,including age,sex,body mass index,nutritional risk screening scores,tumor diameter,tumor location,differentiation,vascular invasion,and Lauren type(all P > 0.05). All patients completed D2 lymphadenectomy,and there were no fluorescent LNs remaining after surgery. The ICG group had a significantly higher mean number of retrieved LNs(33.73± 12.66)than the non-ICG group(26.15±6.31,P < 0.05). Nevertheless,there was no significant difference in the number of positive LNs detected by postoperative pathology between two groups[1(0,6)vs. 0(0,4),P > 0.05]. The ICG group demonstrated superior LN retrieval in both D1 and D2 regions(all P < 0.05),particularly at stations 3,4d,6,7,8a,and 12a. No significant differences were found in operative time,intraoperative blood loss,postoperative hospital stay,complication rates,or postoperative inflammatory indicators on day 3(including CRP、WBC、Alb、AST/ALT)(all P > 0.05). A statistically significant difference in postoperative ventilation time was observed between the two groups(P < 0.05),the ventilation time in the ICG group was found to be superior to the non - ICG group. Conclusion:ICG - NIR fluorescence imaging significantly improves the precision and completeness of LN dissection in RG without compromising perioperative safety.

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陈宣羽,朱陈,林思颖,江志伟,邓正明.吲哚菁绿近红外光成像示踪技术应用于达芬奇机器人胃癌根治术中D2淋巴结清扫的安全性和有效性[J].南京医科大学学报(自然科学版),2025,45(10):1455-1466

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  • 收稿日期:2025-03-17
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  • 在线发布日期: 2025-10-16
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