吲哚菁绿荧光成像技术在腹腔镜困难型胆囊切除术中的应用研究  

Application of indocyanine green fluorescence imaging technology in difficult laparoscopic cholecystectomy

作　　者：陈志 周荣华 朱任飞[2,3] 康东 石亮亮 刘建国 范从彬[1] 吴翔 CHEN Zhi;ZHOU Ronghua;ZHU Renfei;KANG Dong;SHI Liangliang;LIU Jianguo;FAN Congbin;WU Xiang(Department of General Surgery,Rugao Affiliated Hospital of Nanjing University of Traditional Chinese Medicine,Nantong,Jiangsu 226500,China;Department of Hepatobiliary Surgery,Nantong Third People’s Hospital Affiliated to Nantong University,Nantong,Jiangsu 226000,China;Hepatobiliary Center,the First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210000,China)

机构地区：[1]南京中医药大学如皋附属医院普外科,江苏南通226500 [2]南通大学附属南通第三人民医院肝胆外科,江苏南通226000 [3]南京医科大学第一附属医院肝胆中心,南京210000

出　　处：《重庆医学》2022年第17期2984-2987,2992,共5页Chongqing medicine

基　　金：江苏省如皋市指令性科技计划项目(皋科发[2020]26号)。

摘　　要：目的探讨吲哚菁绿荧光成像技术在腹腔镜困难型胆囊切除术中的临床价值。方法选取2018年10月至2021年3月南京中医药大学如皋附属医院及南通大学附属南通第三人民医院收治的54例行腹腔镜困难型胆囊切除术患者为研究对象,分为对照组(30例)和吲哚菁绿组(24例),对照组采用常规腹腔镜胆囊切除术,吲哚菁绿组采用吲哚菁绿胆道荧光指示行腹腔镜胆囊切除术。两组手术均由同一外科手术团队完成,结合手术记录、手术视频及影像检查资料,对比分析两组相关手术情况。结果与对照组比较,吲哚菁绿组术中出血量更少,手术时间、胃肠功能恢复时间、住院总时间更短,手术并发症发生率更低,差异有统计学意义(P<0.05)。吲哚菁绿组22例肝外胆管荧光成像成功,成功率为91.67%(22/24);造影图像准确显示胆囊管及胆总管的解剖关系与手术实际情况无偏差,造影准确率为100.00%(22/22)。吲哚菁绿组1例术中吲哚菁绿胆道造影指示胆囊管汇入右肝管,从而避免了右肝管误伤。结论胆道外科术中使用吲哚菁绿荧光成像技术可降低手术难度及手术并发症发生率。Objective To investigate the clinical value of indocyanine green fluorescence imaging in difficult laparoscopic cholecystectomy.Methods A total of 54 patients with difficult laparoscopic cholecystectomy who were admitted to Rugao Affiliated Hospital of Nanjing University of Chinese Medicine and the Third People’s Hospital of Nantong University from October 2018 to March 2021 were selected as the research subjects,and were divided into the control group(30 cases)and the indocyanine green group(24 cases).The control group received conventional laparoscopic cholecystectomy,and the indocyanine green group was performed laparoscopic cholecystectomy with indocyanine green biliary fluorescence indicator.The two groups of patients were operated by the same surgical team.Combined with the surgical records,surgical video,and imaging examination data,the related surgical conditions of two groups were compared and analyzed.Results Compared with the control group,the indocyanine green group had less intraoperative blood loss,shorter operation time,shorter recovery time of gastrointestinal function,shorter total length of hospital stay,and lower incidence of operative complications,with statistically significant differences(P<0.05).In indocyanine green group,a total of 22 patients had successful extrahepatic bile duct fluorescence imaging,the success rate was 91.67%(22/24);The anatomical relationship of the cholecystic duct and common bile duct was consistent with the actual operation,the accuracy of angiography was 100.00%(22/22).One patient in the indocyanine green group showed that the cystic duct joined the right hepatic duct according to the intraoperative indocyanine green fluorescein cholangiography,thus avoiding the accidental injury of the right hepatic duct.Conclusion The use of indocyanine green fluorescence imaging technology in biliary surgery can reduce the difficulty of surgery and reduce the incidence of surgical complications.

关 键 词：吲哚菁绿 荧光成像技术 腹腔镜治疗术 胆囊切除术 手术并发症 医源性胆管损伤 

分 类 号：R657[医药卫生—外科学]