ICG蛍光装置を搭載した腹腔鏡による術前マーキング法

A novel method of colonic tattooing using an endoscopic device equipped with fluorescence imaging of indocyanine green

◆要旨：［目的］：インドシアニングリーン（以下，ICG）は血清蛋白と結合するとピーク波長845nmの蛍光を発する．この特性を応用したICG蛍光装置を搭載した腹腔鏡を開発し，大腸癌手術における術前マーキングに応用した方法を報告する．［対象と方法］：患者は65歳，S状結腸癌の女性．腹腔鏡補助下S状結腸切除術が予定された．術前に内視鏡的に，腫瘍周囲の粘膜下層に0.25％ICG溶液を計4箇所（0.5ml/1回）局注した．手術開始後，右下腹部のトロッカーより，ICG蛍光装置を搭載した腹腔鏡で大腸を観察した．[結果]：腫瘍部位に一致して蛍光部位が明瞭に描出された．有害事象は認めなかった．[結語]：ICG蛍光装置を搭載した腹腔鏡を用いた腫瘍部位の同定は安全かつ正確であり，術前マーキング法として有用であると考えられた．

　We report colonic tattooing using a novel endoscopic device equipped with fluorescence imaging of indocyanine green（ICG）.

　A 65-year-old woman was diagnosed as having sigmoid colon cancer in our hospital. Injections using 0.5 ml of 0.25%ICG were placed into the submucosal space of the bowel wall at four quadrants circumferentially around the lesion, during preoperative colonoscopy. Intraoperatively, after a camera port was inserted, the colon was observed using a charge coupled endoscopic device with a cut filter as the detector, and light emitting xenon below 800 nm as the light source. Tumor localization was clearly visualized and was easily and accurately identified after being fluoresced, where as the tumor localization was not visible under the naked eye as a green spot. There was no complication.

　Colonic tattooing using an endoscopic device equipped with fluorescence imaging of ICG is a new concept of colonic marking method based on the characteristics that ICG is a near infrared fluorescent dye, and is useful without adverse effects for identifying the tumor localization at laparoscopic surgery.