使用吲哚菁绿 (ICG) 荧光成像可以清楚地识别由胆道肿瘤或血栓形成引起的肝脏胆汁淤积区域。1 作者团队报道了胆管阻塞区域成像 (BOAI) 辅助开腹肝切除术治疗肝内胆汁淤积的应用。胆管癌 (ICC) 合并肝内胆管梗阻。2 该视频是首例使用 3D-4K 荧光成像系统进行实时 BOAI 引导的三维 (3D) 腹腔镜肝切除术的报道。一名 65 岁男性因华支睾吸虫病被送入提交人所在的机构。术前计算机断层扫描（CT）和磁共振胰胆管造影（MRCP）显示右肝管梗阻和弥漫性扩张。术前5天进行15分钟ICG保留（ICG R15），结果为3.3%。术前计划包括在可视化技术辅助下进行腹腔镜右半肝切除术和区域淋巴结清扫。3手术过程中，荧光成像显示右肝有明显的荧光积累。在实时BOAI的引导下（图1），精确切除胆道梗阻区域，在切割面上被动充分暴露肝中静脉（MHV）。图 1 实时胆管阻塞区域成像的管理步骤。术前3-5天静脉​​注射ICG，剂量0.5mg/kg。 B ICG 在注射后几分钟内在整个肝脏中积累。 C ICG 被肝脏选择性吸收并排泄至肠道，从而滞留在胆道梗阻区域。 结果：组织病理学诊断为右侧胆管肿瘤的高级别上皮内瘤变，无淋巴结转移和华支睾吸虫病。手术时间300分钟，术中失血50毫升。术后未出现并发症，7天后出院。实时BOAI指导下腹腔镜右半肝切除胆管梗阻区可行、有效。© 2024. 肿瘤外科学会。

The regions of the liver with cholestasis caused by biliary tumors or thrombosis can be distinctly identified using indocyanine green (ICG) fluorescence imaging.1 The authors' team reported the application of bile-duct obstructed area imaging (BOAI) to assist open hepatectomy for intrahepatic cholangiocarcinoma (ICC) combined with intrahepatic bile duct obstruction previously.2 This video is the first report of real-time BOAI-guided three-dimensional (3D) laparoscopic hepatectomy using a 3D-4K fluorescence imaging system.A 65-year-old man was admitted to the authors' institution with clonorchiasis. Preoperative computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) showed an obstruction and diffuse dilation of the right hepatic duct. A 15-min retention of ICG (ICG R15) was performed 5 days before the operation, with a 3.3% result. Preoperative planning involved performing laparoscopic right hemi-hepatectomy with regional lymph node dissection assisted by visualization technology.3 During the procedure, significant fluorescence accumulation in the right liver was shown by fluorescence imaging. With the guidance of real-time BOAI (Fig. 1), the regions of biliary obstruction were precisely resected, and the middle hepatic vein (MHV) was passively and adequately exposed on the cutting plane. Fig. 1 Administration steps for real-time bile duct-obstructed area imaging. A ICG is injected intravenously 3-5 days before operation at a dose of 0.5 mg/kg. B ICG is accumulated in the whole liver within a few minutes after injection. C ICG is selectively absorbed by the liver and excreted into the intestines, whereby it is retained in areas of biliary obstruction RESULTS: The histopathologic diagnosis indicated high-grade intraepithelial neoplasia of the right bile duct tumor without lymph node metastases and clonorchiasis. The duration of the operation was 300 min, with an intraoperative blood loss of 50 ml. No postoperative complications occurred, and the patient was discharged after 7 days.Laparoscopic right hemi-hepatectomy for the bile-duct obstructed area with the guidance of real-time BOAI is feasible and effective.© 2024. Society of Surgical Oncology.