术中静脉注射吲哚菁绿在慢性萎缩性胆囊炎腔镜手术中的应用  

Application of intraoperative intravenous injection of indocyanine green in endoscopic surgery for chronic atrophic cholecystitis

作　　者：符庆胜 金雷 李涛 张旭东 朱春富 秦锡虎 吴宝强 Fu Qingsheng;Jin Lei;Li Tao;Zhang Xudong;Zhu Chunfu;Qin Xihu;Wu Baoqiang(Bengbu Medical College Graduate School,Bengbu 233030,China;Department of Hepatobiliary and Pancreatic Surgery,the Affiliated Changzhou No.2 People′s Hospital of Nanjing Medical University,Changzhou 213003,China)

机构地区：[1]蚌埠医学院研究生院,233030 [2]南京医科大学附属常州第二人民医院肝胆胰外科,213003

出　　处：《国际外科学杂志》2022年第1期5-10,F0003,共7页International Journal of Surgery

摘　　要：目的探讨术中静脉注射吲哚菁绿在慢性萎缩性胆囊炎腔镜手术中辨清肝外胆管结构的临床价值。方法回顾性分析2020年1月—2021年7月南京医科大学附属常州第二人民医院肝胆胰外科收治的110例诊断为慢性萎缩性胆囊炎行腹腔镜胆囊切除术(LC)的患者资料,术前所有患者均行腹部B超检查明确诊断,按照术中是否静脉注射吲哚菁绿将其分为实验组(n=55)和对照组(n=55),实验组术中经外周静脉注射吲哚菁绿5 mg,术中吲哚菁绿荧光显影技术导航下行LC。对照组行常规LC。统计实验组胆囊管、胆总管、肝总管的显影率及显影时间,比较两组患者的一般临床资料、辨清三管时间、手术时间、术中出血量、放置腹腔引流管及拔管时间、中转开腹及胆管损伤、术后住院时间、术后第一次复查丙氨酸氨基转移酶(ALT)、谷氨酰转移酶(GGT)水平、随访等结果。服从正态分布的计量资料采用均数±标准差(±s)表示,两组比较采用独立样本t检验。偏态分布的计量资料以M(Q_(1),Q_(3))描述,采用非参数检验中的Mann-Whitney U检验。计数资料组间比较采用χ^(2)检验或Fisher确切概率法。结果两组均成功实施手术,实验组所有患者均成功显影肝总管,54例显影胆总管,52例可显影胆囊管,且显影三管时间为(15.8±1.2)min。实验组中辨清三管时间、手术时间、术中出血量及放置腹腔引流管病例分别为(18.5±1.3)min、(64.0±6.8)min、(16.3±6.7)mL、43例,对照组分别为(46.3±8.1)min、(98.7±10.5)min、(53.6±14.9)mL、55例,实验组均明显低于对照组,两组相比差异有统计学意义(P<0.05)。实验组无中转开腹及胆管损伤病例,对照组有1例中转开腹及1例胆管损伤病例,两组差异无统计学意义(P>0.05)。两组术后拔管时间及术后住院时间差异有统计学意义(P<0.05)。实验组患者术后第一次复查ALT、GGT水平分别为47(31,75)U/L、38(19,114)U/L,对照组分�Objective To investigate the clinical value of intraoperative intravenous injection of indocyanine green in differentiating extrahepatic bile duct structure in chronic atrophic cholecystitis.Methods A retrospective analysis was performed on the data of 110 patients diagnosed with chronic AC who underwent laparoscopic cholecystectomy(LC)admitted to the Department of Hepatobiliary and pancreatic Surgery of Changzhou Second People′s Hospital from January 2020 to July 2021.All patients were confirmed by abdominal B-ultrasound before surgery.The patients in the experimental group were divided into experimental group(n=55)and control group(n=55)according to whether indocyanine green was intravenously injected during the operation.The experimental group was intravenously injected with 5 mg indocyanine green during the operation,and LC was navigated by indocyanine green fluorescence imaging technique during the operation.The control group received routine LC.The imaging rate and imaging time of the cystic duct,common bile duct,and common hepatic duct in the experimental group were compared.The clinical data,identify three tube time,operation time,intraoperative blood loss,abdominal cavity drainage placement and extubation time,transfer laparotomy and bile duct injury,postoperative hospital stay,postoperative first review of alanine aminotransferase(ALT),glutamine transferase(GGT)of leveling and follow-up were compared between the two groups.The measurement data subject to normal distribution were expressed by Mean±standard deviation(±s),and the two groups were compared by independent sample t test.The measurement data of skewness distribution were described by M(Q1,Q3)and the manhui method in nonparametric test was used Mann-whitney U test.The chi-square test or Fisher′s exact probability method was used for comparison between groups of count data.Results Operation was performed successfully in both groups.In the experimental group,the common hepatic duct,common bile duct and gallbladder duct were developed success

关 键 词：胆囊炎 胆囊切除术 腹腔镜 慢性萎缩性胆囊炎 吲哚菁绿 荧光显影 胆管损伤 

分 类 号：R657.41[医药卫生—外科学]