Preliminary application of indocyanine green fluorescence imaging technology in nasal endoscopic tumor surgery
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摘要: 目的 初步探讨吲哚菁绿(indocyanine green，ICG)分子荧光成像技术在鼻内镜下肿瘤手术中的应用价值。方法 以2022年12月—2023年4月间新疆军区总医院耳鼻咽喉头颈外科5例鼻腔鼻窦、眶壁、颅底相关肿瘤患者作为研究对象，其中良性肿瘤3例，恶性肿瘤2例。所有患者皆在ICG分子荧光成像技术指导下完成手术。术前12~24 h按0.5 mg/kg剂量经肘静脉静推ICG；术中通过荧光成像对肿瘤进行标记，术者严格按标记范围、深度清除肿物组织，恶性肿瘤根据病检结果做进一步扩大清理。结果 5例患者在荧光成像技术辅助下，均实现了精准的肿瘤定位；参照荧光标记界限进行切除，对患者均做到了肿瘤的彻底清理或切缘阴性。结论 针对鼻内镜下肿瘤相关手术，ICG分子荧光成像技术不仅能做到实时精准定位，而且能为术者判断肿瘤边界提供依据。因此认为该项技术在鼻内镜肿瘤手术中应具有一定的应用价值。Abstract: Objective To preliminarily study the practical value of Indocyanine green(ICG) molecular fluorescence imaging technology in nasal endoscopic tumor surgery.Methods Five patients with tumors related to nasal sinuses, orbital wall and skull base in the Department of Otolaryngology head and Neck Surgery, General Hospital of Xinjiang Military Command from December 2022 to April 2023 were enrolled. Among them, 3 were benign tumors and 2 were malignant tumors. All patients underwent surgery under the guidance of ICG molecular fluorescence imaging. ICG was administered intravenously through cubital vein at a dose of 0.5 mg/kg 12 to 24 h before surgery. Tumors were labeled by fluorescence imaging during the operation. surgeons cleared the tumor tissue strictly according to the labeled range and depth, malignant tumors were further expanded and cleaned according to pathology results.Results All 5 patients achieved accurate tumor localization with the aid of fluorescence imaging technology. Resections were performed with reference to fluorescent labeling boundaries, all patients achieved complete tumor cleanup or negative margins.Conclusion For tumor-related surgery under nasal endoscopy, ICG molecular fluorescence imaging technology can not only achieve accurate real-time positioning, but also provide evidence for surgeons to judge tumor boundaries. Therefore, we believe that the technology should have certain practical value in nasal endoscopic tumor surgery.
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Key words:
- skull base tumor /
- fluorescent dye /
- indocyanine green /
- diagnostic imaging /
- nasal cavity /
- endoscopic surgery
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表 1 术中ICG荧光成像病例的一般资料、用药方法、显像情况、病理类型及不良反应情况
病例 性别 年龄/岁 伴发疾病 ICG剂量/mg/kg ICG术前注射时间/h 肿瘤部位 显像效果 病理类型 ICG不良反应 1 女 29 无 0.5 24 左上颌窦、翼腭窝 良好 出血坏死性息肉 无 2 女 45 糖尿病 0.5 12 右额窦、筛窦、眼眶、前颅底 良好 孤立性纤维瘤 无 3 女 53 高血压 0.5 24 左蝶窦、鼻腔 良好 恶性黑色素瘤 无 4 男 67 高血压 0.5 24 垂体 正常组织与病灶对比度稍差，但仍能分辨 垂体瘤 无 5 男 49 无 0.5 24 左上颌窦、鼻腔 良好 内翻性乳头状瘤 无 
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