肝臟手術界的GPS來了！
精準肝臟手術新技術-螢光導引肝癌微創手術
隨著科技的進步，以往大傷口、高出血量的傳統肝臟開腹手術也漸漸走向小傷口、少出血量的微創手術，近年來我們更引進了螢光內視鏡系統，手術時在螢光的導引下我們可以更精確的掌握肝癌的位置，對病人進行更精準、更小部分的肝臟切除並完整除去肝腫瘤。
在本院肝臟外科，以螢光影像導引進行肝臟手術的方法主要有三種，依不同位置採取不同之策略 :
第一種
當腫瘤位於肝表面時，因腫瘤有吸收螢光劑的特性，直接使用螢光內視鏡即可偵測到並直接切除。
第二種
當腫瘤不大且在較深的位置時，可在肝節動脈或肝節門靜脈施打螢光劑以進行螢光顯影單一肝節之切除。
第三種
腫瘤較大時佔據兩肝節以上時，可以截斷其支配血管後，於手部靜脈施打螢光劑，無螢光顯影部分即為須切除部分，以下案例為第一種情形也是最常見的案例。
ㄧ位47歲男性因B型肝炎在本院肝膽科接受治療並追蹤六年，期間接受抗病毒治療已使表面抗原陽轉陰，去年九月定期的超音波追蹤意外發現一顆1.3公分的肝腫瘤經進一步檢查確診為肝癌後轉至本科接受手術評估。在確認病患狀況與腫瘤大小及位置後我們決定以螢光導引肝癌微創手術為病人進行治療，在螢光導引下我們可以清楚地看見腫瘤的位置及其侵犯的區域，針對腫瘤進行小範圍且精準之微創肝臟切除手術，整個手術出血量只有10cc，術後檢視檢體也可看見腫瘤已切除乾淨且邊緣安全。相較於傳統手術術後常因傷口疼痛而需臥床，行走困難，病人術後第一天即可如常人一般正常進食、活動，不到一周即順利出院。
GPS of Liver Surgery!
Precision liver surgery: 【ICG Fluorescence Imaging-guided Minimally Invasive Surgery for Liver Cancer】
With the vast advances of science and technology, minimally invasive surgery featuring minor wounds and less blood loss has gradually replaced open liver surgery in many cases. In order to locate positions of liver tumors more accurately, we also introduced ICG Fluorescence Imaging system that helps surgeons perform liver resections precisely and completely. In our hospital, there are three ways of using ICG Fluorescence Imaging depending on different positions of tumors. First, when a tumor is on liver surface, a surgeon will use endoscopic ICG system to identify and remove a tumor directly since tumors naturally absorb more ICG than other tissues. Second, for minor but deep-seated tumors, liver resection is performed after segmental hepatic artery or portal vein is given the ICG injection. Third, if a liver tumor is larger and has occupied two segments, surgeons could cut off its dominant vessels, inject ICG into hand veins, and resect the part without fluorescence imaging. The following is the one of the most common cases using the first way we mentioned above.
A 47-year-old male with Hepatitis B has been under treatment and followed for six years and has become HBsAg negative afterward. However, he was diagnosed as hepatic cancer with a 1.3 cm tumor after an ultrasound scan last September. We decided to have the patient undergo minimally invasive surgery using ICG fluorescence imaging system, which assisted us to see the position of the tumor clearly and perform liver resection precisely. The blood loss of the operation was merely 10 cc, and the tumor was entirely removed. Most of all, the patient could have meals normally and move about with ease on the very first day after surgery.
延伸閱讀 : 【聯合報】我肝移植成功率逾八成，高雄長庚雙冠王
延伸閱讀 : 手術切除肝癌在巴塞隆納肝癌治療指引建議與不建議手術切除肝癌的預後分析
延伸閱讀 : 【華視新聞】醫援海外不藏私 陳肇隆將愛傳遞全球
延伸閱讀 : 【ETtoday】婦人「足球大血管瘤」突破裂休克 換肝之父陳肇隆拚11小時救命
