Application of visual fluorescence imaging in thoracic surgery
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摘要: 可视化荧光成像是一种新兴的外科辅助技术，近年来被广泛应用于多个外科领域。荧光染料具有实时可视化成像特性，可以显示患者的肿瘤、血供、淋巴、神经等不同解剖结构，从而提高手术的准确性和术后恢复，并可能由此改变手术方法。针对胸部疾病，可视化荧光成像技术在肺结节检出定位，肿瘤切缘和残留识别，胸腔镜手术中肺段间平面识别，预防食管切除术后吻合口瘘，辨认术中胸导管和治疗术后乳糜漏，绘制前哨淋巴结等方面具有良好的临床指导意义。为了评估在不同手术场景下对荧光引导的不同需求，我们分别阐述了成像技术和荧光剂的临床前研究和临床应用进展，至此标志着可视化荧光成像技术的日趋成熟，以及在胸部外科中广泛的应用前景。Abstract: Visual fluorescence imaging is a new surgical assistant technology, which has been widely used in many surgical fields in recent years. Fluorescent dyes have real-time visual imaging characteristics, which can display different anatomical structures such as tumor, blood supply, lymph and nerve, so as to improve the accuracy of operation and postoperative recovery, and may change the operation method. For chest diseases, visual fluorescence imaging technology has good clinical guiding significance in the detection and positioning of pulmonary nodules, the identification of tumor cutting edge and residue, the identification of lung segment plane in thoracoscopic surgery, the prevention of anastomotic leakage after esophagectomy, the identification of intraoperative thoracic duct and the treatment of postoperative chylous leakage, and the mapping of sentinel lymph nodes. In order to evaluate the different needs for fluorescence guidance in different surgical scenes, we described the preclinical research and clinical application progress of imaging technology and fluorescent agent respectively. So far, it marks the increasing maturity of visual fluorescence imaging technology and its wide application prospect in thoracic surgery.
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Key words:
- visualization /
- fluorescence imaging /
- ICG /
- surgical assistance
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表 1 主流近红外成像系统
Table 1. Mainstream near infrared imaging system
企业 成像系统 成像模式 适用场景 Karl Storz
(卡尔史托斯公司，德国）Image1 STM RubinaTM 4K分辨率 腔镜 OPA1®NIR/ICG成像技术
（叠加成像模式）
S成像技术
LED光源（不使用激光）Image1 STM 白光及PDD模式下全高清图像 腔镜 脚踏实现模式切换
无覆盖模式Stryker
(史赛克公司，美国）1688AIM 4K 4K分辨率 腔镜 绿色叠加模式
L11光源和自动照明技术SPY-PHI 基于1688AIM 4K的便携设备 开放 白光，SPY荧光模式
(叠加成像模式）
颜色分段模式Quest Medical Imaging (奥林巴斯，日本） Quest Spectrum® HD图像 腔镜和开放 Imaging
（奥林巴斯，日本）两个专用NIR通道同时捕获彩色和最多两个的荧光图像 Intuitive Surgical Devices Inc.
（直觉外科，美国）Firefly® DAVinci Si and Xi Surgical Robots DA Vinci Xi与Firefly荧光成像系统兼容，实现普通和荧光模式的切换[2] 机器人系统 Hamamatus Photonics
（滨松光子学公司，澳大利亚、欧盟、日本）PDE-NeoⅡ 手持式成像系统
黑白和彩色图像开放 NIR: 近红外反射; ICG: 吲哚菁绿; LED: 发光二极管; HD: 高分辨率. 
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