Name: indocyanine green-guided intraoperative imaging to facilitate video-assisted retroperitoneal debridement for treating acute necrotizing pancreatitis
Uploaded: 2022-09-08T15:00:00
Description: Watch this Scientific Journal Video about Indocyanine Green-Guided Intraoperative Imaging to Facilitate Video-Assisted Retroperitoneal Debridement for Treating Acute Necrotizing Pancreatitis at JoVE.c

作者感谢郭宇教授和华云鹏教授（中山大学附属第一医院肝外科）提供的建议和认真的审查。这项工作得到了国家自然科学基金（81201919），广东省自然科学基金（2017A030313495）的支持。

研究方案经中山大学第一附属医院伦理委员会批准，研究依据《赫尔辛基宣言》进行。从患者那里获得了书面知情同意书。
1. 纳入-排除标准
<ol><li>包括有感染性坏死证据且需要有侵入性干预指征的成人急性胰腺炎患者。 注意：当在患者中观察到以下三个特征中的至少两个时，定义急性胰腺炎：1）典型的上腹痛，2）血清淀粉酶或脂肪酶水平高于正常水平的三...

<ol>
	<li>Trikudanathan, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Current+concepts+in+severe+acute+and+necrotizing+pancreatitis:+An+evidence-based+approach.">Current concepts in severe acute and necrotizing pancreatitis: An evidence-based approach.</a> Gastroenterology. 156 (7), 1994-2007 (2019).</li><li>Baron, T. H., DiMaio, C. J., Wang, A. Y., Morgan, K. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=American+Gastroenterological+Association+clinical+practice+update:+Management+of+pancreatic+necrosis.">American Gastroenterological Association clinical practice update: Management of pancreatic necrosis.</a> Gastroenterology. 158 (1), 67-75 (2020).</li><li>Raraty, M. G. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Minimal+access+retroperitoneal+pancreatic+necrosectomy:+improvement+in+morbidity+and+mortality+with+a+less+invasive+approach.">Minimal access retroperitoneal pancreatic necrosectomy: improvement in morbidity and mortality with a less invasive approach.</a> Annals of Surgery. 251 (5), 787-793 (2010).</li><li>Dhingra, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Single+or+multiport+percutaneous+endoscopic+necrosectomy+performed+with+the+patient+under+conscious+sedation+is+a+safe+and+effective+treatment+for+infected+pancreatic+necrosis+(with+video).">Single or multiport percutaneous endoscopic necrosectomy performed with the patient under conscious sedation is a safe and effective treatment for infected pancreatic necrosis (with video).</a> Gastrointestinal Endoscopy. 81 (2), 351-359 (2015).</li><li>Gomatos, I. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Outcomes+from+minimal+access+retroperitoneal+and+open+pancreatic+necrosectomy+in+394+patients+with+necrotizing+pancreatitis.">Outcomes from minimal access retroperitoneal and open pancreatic necrosectomy in 394 patients with necrotizing pancreatitis.</a> Annals of Surgery. 263 (5), 992-1001 (2016).</li><li>Boni, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+applications+of+indocyanine+green+(ICG)+enhanced+fluorescence+in+laparoscopic+surgery.">Clinical applications of indocyanine green (ICG) enhanced fluorescence in laparoscopic surgery.</a> Surgical Endoscopy. 29 (7), 2046-2055 (2015).</li><li>Nardi, P. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+angiography+with+indocyanine+green+to+assess+anastomosis+perfusion+in+patients+undergoing+laparoscopic+colorectal+resection:+results+of+a+multicenter+randomized+controlled+trial.">Intraoperative angiography with indocyanine green to assess anastomosis perfusion in patients undergoing laparoscopic colorectal resection: results of a multicenter randomized controlled trial.</a> Surgical Endoscopy. 34 (1), 53-60 (2020).</li><li>Newton, A. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraoperative+near-infrared+imaging+can+identify+neoplasms+and+aid+in+real-time+margin+assessment+during+pancreatic+resection.">Intraoperative near-infrared imaging can identify neoplasms and aid in real-time margin assessment during pancreatic resection.</a> Annals of Surgery. 270 (1), 12-20 (2019).</li><li>Cai, Y., Zheng, Z., Gao, P., Li, Y., Peng, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+duodenum-preserving+total+pancreatic+head+resection+using+real-time+indocyanine+green+fluorescence+imaging.">Laparoscopic duodenum-preserving total pancreatic head resection using real-time indocyanine green fluorescence imaging.</a> Surgical Endoscopy. 35 (3), 1355-1361 (2021).</li><li>Santvoort, H. C. v., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dutch+pancreatitis+study+group.+A+step-up+approach+or+open+necrosectomy+for+necrotizing+pancreatitis.">Dutch pancreatitis study group. A step-up approach or open necrosectomy for necrotizing pancreatitis.</a> The New England Journal of Medicine. 362 (16), 1491-1502 (2010).</li><li>Bakker, O. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dutch+Pancreatitis+Study+Group.+Endoscopic+transgastric+vs+surgical+necrosectomy+for+infected+necrotizing+pancreatitis:+a+randomized+trial.">Dutch Pancreatitis Study Group. Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial.</a> JAMA. 307 (10), 1053-1061 (2012).</li><li>Brunschot, S. v., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dutch+Pancreatitis+Study+Group.+Endoscopic+or+surgical+step-up+approach+for+infected+necrotising+pancreatitis:+a+multicentre+randomised+trial.">Dutch Pancreatitis Study Group. Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial.</a> Lancet. 391 (10115), 51-58 (2018).</li><li>Bang, J. 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本研究表明，ICG引导的实时术中近红外荧光成像可能有益于VARD清创过程中的灌注评估和邻近正常组织的可视化。
在微创时代，由PCD或内镜透壁引流，然后内镜下坏死切除术或手术清创术（如VARD）组成的升级方法被认为是严重急性坏死性胰腺炎患者的标准治疗方法1。如几项大型随机试验（PANTER试验、MISER试验等）所示。10，11，12，13 并在临...

急性胰腺炎（AP）是最常见的消化系统疾病之一，给患者带来巨大的医疗和经济负担。大约 20% 的 AP 患者会出现严重的急性胰腺炎 （SAP），并发感染性坏死或持续性器官功能障碍1。SAP 通常与较高的发病率和死亡率（高达 30%）相关1。对于感染性坏死患者，经皮引流 （PCD） 后持续性器官功能障碍或无法恢复，或患有胃肠道或胆道梗阻，应考虑手术清创1，2。
在微创时代，除了开放手术外，还有多种手术清创方法，包括内镜腔内坏死切除术、腹腔镜或开放性经胃清创术以及视频辅助腹膜后清创术（VARD），这是升级方法的一部分1，2。对于左侧分布的感染性坏死延伸至结肠旁沟或腹膜后深部的患者，VARD 是首选方法2。由于广泛的腹膜后粘连，腹腔镜下白光图像中坏死碎片和邻近炎症正常组织之间很少有任何视觉上清晰的分离表面，因此 VARD 不可避免地伴有血管损伤、胰腺外皮肤或肠皮肤瘘的风险3，4，5。
吲哚菁绿 （ICG） 的实时术中近红外荧光成像已被应用于促进肠道6，7 的灌注评估以及胆道和血管解剖结构8，9 的可视化。鉴于VARD的上述缺点，我们在VARD期间应用了ICG的实时近红外荧光成像，能够可视化灌注良好的相邻正常组织和血管结构。这种改良技术（ICG 引导的 VARD）可以在手术清创期间提供清晰的分离表面，并降低血管或肠道损伤的风险。ICG 引导下的 VARD 可能有助于外科医生在治疗严重急性坏死性胰腺炎时进行更安全的清创术。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>The 4K Ultra HD Fluorescence Endoscopic Navigation System</td>
			<td>Guangdong OptoMedic Technologies Inc</td>
			<td>OPTO-CAM214K</td>
			<td>fluorescence laparoscopy</td>
		</tr>
		<tr>
			<td>indocyanine green</td>
			<td>DanDong YiChuang Pharmaceutical CO., LTD</td>
			<td>H20055881</td>
			<td>indocyanine green injection for fluorescence imaging</td>
		</tr>
	</tbody>
</table>

indocyanine green-guided intraoperative imaging to facilitate video-assisted retroperitoneal debridement for treating acute necrotizing pancreatitis

视频辅助腹膜后清创术 （VARD） 是一种可行的微创坏死切除术方法，用于治疗严重急性坏死性胰腺炎，如果它不能消退或伴有腹膜后感染性坏死。由于广泛的腹膜后粘连，坏死碎片和邻近炎症正常组织之间在白光图像中很少有任何视觉上清晰的分离表面，因此 VARD 伴有血管损伤、胰腺外皮肤或肠皮肤瘘的风险。鉴于上述缺点，我们在VARD期间应用吲哚菁绿（ICG）的实时术中近红外荧光成像，从而能够可视化灌注良好的相邻正常组织。这种改良技术（ICG 引导的 VARD）可以在清创过程中提供清晰的分离表面，并降低血管或肠道损伤的风险。ICG 引导下的 VARD 可能有助于外科医生在治疗严重急性坏死性胰腺炎时进行更安全的清创术。

自 2021 年 6 月起，ICG 引导下的 VARD 已在 3 名重症急性坏死性胰腺炎患者中成功实施。这些患者在基线时和VARD后的特征包括 表1。 第一位接受ICG引导的VARD的患者是一名41岁的男性患者，他于2021年6月20日入院。他患有中度急性坏死性胰腺炎。腹部增强CT扫描显示（ 如图 1和 表1所示），坏死积液由小弧、胰周间隙组成，并延伸至双侧腹膜后。初始PCD引?...

Watch this Scientific Journal Video about Indocyanine Green-Guided Intraoperative Imaging to Facilitate Video-Assisted Retroperitoneal Debridement for Treating Acute Necrotizing Pancreatitis at JoVE.c

Indocyanine Green-Guided Intraoperative Imaging to Facilitate Video-Assisted Retroperitoneal Debridement for Treating Acute Necrotizing Pancreatitis

该方案介绍了吲哚菁绿引导的视频辅助腹膜后清创术（ICG 引导的 VARD）用于治疗严重急性坏死性胰腺炎。

吲哚菁绿色引导术中影像学促进视频辅助腹膜后清创治疗急性坏死性胰腺炎

Video-assisted retroperitoneal debridement (VARD) is a feasible, minimally invasive necrosectomy method for treating severe acute necrotizing ...

该方案介绍吲哚菁绿引导的视频辅助腹膜后清创术，用于治疗严重急性坏死性胰腺炎。ICG 引导的 VARD 是一种简单可行的方法，用于可视化肠系膜血管灌注良好的相邻正常组织和血管结构。首先沿扩张道插入一个 12 毫米腹腔镜穿刺器到腹膜后坏死集合。如果需要更宽的清创空间，请通过 12 毫米穿刺器注入二氧化碳，使用二氧化碳气腹膜。然后通过观察套管放置近红外荧光腹腔镜，并在腋下中线的左侧或右侧再做一个 10 毫米的切口，如文本手稿中所述。插入 10 毫米手术穿刺器并将腹腔镜的显示模式切换到多显示模式，然后再从邻近的正常组织中分离坏死碎片。在外周静脉静脉注射第一推吲哚菁绿或ICG，然后用10毫升生理盐水冲洗。10至20秒后，在荧光场中可视化相邻正常组织或血管的峰值灌注。更明显的分离表面将与碎片区分开来。使用腹腔镜抓手清除灌注不良和松散粘附的坏死碎片。避免撕裂下面的肠或血管。如果 ICG 荧光衰减，则再次静脉推注 ICG。去除大部分坏死碎片后，用生理盐水冲洗腹膜后腔，并用腹腔镜吸引器抽吸，直到灌洗液变得清澈。清创后，在进行筋膜和皮肤缝合之前，在腔的最深处放置至少一对引流管。41岁男性患者患有中度急性坏死性胰腺炎，并接受了ICG引导的VARD。腹部对比增强CT扫描显示坏死积液由较小的胰弧周围间隙组成，并延伸至双侧腹膜后。初次经皮引流后，右侧腹膜后感染性坏死持续存在，并且在胰腺炎发作后约四周进行了第一次VARD。在荧光场中可视化相邻正常组织或血管的ICG灌注，并将更清晰的分离表面与碎片区分开来。感染性坏死得到解决，引流管在ICG引导下VARD后7天被移除。ICG指导的VARD需要进一步的随机临床试验，以确认其实用性并安全治疗急性坏死性胰腺炎。

Research

JoVE Journal

Medicine

Multispectral Real-time Fluorescence Imaging for Intraoperative Detection of the Sentinel Lymph Node in Gynecologic Oncology

多光谱实时荧光成像术在妇科肿瘤前哨淋巴结的检测

The prognosis in virtually all solid tumors depends on the presence or absence of lymph node metastases.1-3 Surgical treatment most often combines radical ...

科研

医学

Non-invasive Imaging of Acute Allograft Rejection after Rat Renal Transplantation Using 18F-FDG PET

Non-invasive Imaging of Acute Allograft Rejection after Rat Renal Transplantation Using 18F-FDG PET

大鼠肾移植后急性排斥反应的非侵入性的成像使用<sup&gt; 18</sup&gt; F-FDG PET

The number of patients with end-stage renal  disease, and the number of kidney allograft recipients continuously increases.  Episodes of acute cellular ...

Ovine Lumbar Intervertebral Disc Degeneration Model Utilizing a Lateral Retroperitoneal Drill Bit Injury

Ovine Lumbar椎间盘退变模型利用横向腹膜后位钻伤

Intervertebral disc degeneration is a significant contributor to the development of back pain and the leading cause of disability worldwide. Numerous ...

Robotic Lateral Pancreaticojejunostomy for Chronic Pancreatitis

慢性胰腺炎的机器人侧胰腺肌切除术

Lateral pancreaticojejunostomy (LPJ) has shown good postoperative outcomes in patients with painful, morphine dependent, chronic pancreatitis (CP). The ...

Posterior Approach for Debridement of the Psoas Abscess

切除普索阿脓肿的后向方法

This method focuses on outlining a safe zone for irrigation and debridement of a psoas abscess through a posterior approach. Initially, an anterior ...

Sodium Taurocholate Induced Severe Acute Pancreatitis in C57BL/6 Mice

牛磺胆酸钠诱导C57BL / 6小鼠严重急性胰腺炎

Biliary acute pancreatitis induction by sodium taurocholate infusion has been widely used by the scientific community due to the representation of the ...

Establishment of a Mouse Severe Acute Pancreatitis Model using Retrograde Injection of Sodium Taurocholate into the Biliopancreatic Duct

建立小鼠重症急性胰腺炎模型，将牛磺胆酸钠逆行注射到胆胰管中

The prevalence of acute pancreatitis (AP), especially severe acute pancreatitis (SAP), is increasing in younger age groups annually. However, there is a ...

Robotic Left Hepatectomy using Indocyanine Green Fluorescence Imaging for an Intrahepatic Complex Biliary Cyst

使用吲哚菁绿荧光成像进行机器人左肝切除术治疗肝内复合胆囊肿

Biliary cysts (BC) are rare congenital dilatations of intra- and extrahepatic parts of the biliary tract and bear a significant risk of carcinogenesis. ...

In Vitro Apical-Out Enteroid Model of Necrotizing Enterocolitis

In Vitro Apical-Out Enteroid Model of Necrotizing Enterocolitis

体外 坏死性小肠结肠炎的顶端出肠样模型

Necrotizing enterocolitis (NEC) is a devastating disease affecting preterm infants, characterized by intestinal inflammation and necrosis. Enteroids have ...

Establishment of a Simple and Effective Rat Model for Intraoperative Parathyroid Gland Imaging

建立简单有效的术中甲状旁腺成像大鼠模型

Parathyroid gland (PG) identification is a critical unmet need in thyroidectomy. The identification of the PG is challenging in thyroid surgery as it is ...