Application of different ways of ICG injection in the identification of pelvic lymph nodes under fluorescence laparoscopy
Objective To explore the effect of identifying pelvic lymph nodes by different injection of indocyanine green(ICG)during fluorescent laparoscopic radical cystectomy.Methods The data of 54 male bladder cancer patients admitted to the First Hospital of Shanxi Medical University from September 2021 to September 2022 were analyzed.Preoperative cystoscopic biopsy all revealed a pathological diagnosis of urothelial carcinoma.All patients underwent fluorescent laparoscopic radical cystectomy plus pelvic lymph node dissection.They were divided into 3 groups according to the annotated route:6 in the medial malleolus injection group,68(61,73)years;4 in the perineal injection group,67(59,74)years;44 in the medial malleolus and perineum,64(45,78)in the combined injection group.Under general anesthesia,patients were placed in the supine position with 0.3 to 0.5 ml of subcutaneous ICG solution(2.5 mg/ml)injected from 1.0 to 1.5 h before surgery.In the medial malleolus injection group,0.3 to 0.5 ml(0.75 mg/place)was injected at 2 cm above the medial malleolus and 0.3 to 0.5 ml(0.75 mg/place)at two symmetrical sites above the anus.Intraoperatively,4K fluorescent laparoscopy was used to observe the color development of the injection site and lymphatic vessels in vitro,and then to observe the development of pelvic lymph nodes in vivo.Results In 3 groups,inguinal lymph nodes were developed about 30 min after ICG injection,and 1 h later,the longest(4.5±0.3)h.The external iliac and common iliac lymph nodes,the obturatorius lymph nodes in the perineal injection group,and the inguinal,obturatorius,external iliac,internal,anterior sacral,and common iliac lymph nodes in the medial malleolar and perineal injection group.In this study,in 54 cases,the postoperative pathological examination confirmed that the removed fluorescently labeled tissue was lymph node tissue,and the lymph node detection rate was 100％.The postoperative stage was pT2,14,32 pT3 and 8 pT4;4 pNx,44 pN0,5 pN1 and 1 pN2.In the medial malleolar injection group,2 patients staged pT2,3 stage pT3,1 stage pT4;1 stage pNx stage,4 stage pN0 and 1 stage pN1 stage.In the perineal injection group,4 patients had postoperative pathological stage pT3N0;in the medial malleolar and perineal injection group,12 pT2,25 and 7 pT3;3 pNx,36 pN0,4 pN,and 1pN2.Conclusions ICG injection through the perineum and subcutaneous labeling of pelvic lymph nodes,and the simple malleolus or perineal injection can not completely develop the pelvic lymph nodes.The combined injection could fully develop the pelvic lymph nodes,which may accurately guide the operator to locate,identify and remove pelvic lymph nodes.
万方数据
维普
