吲哚菁绿荧光显像在有上腹部手术史的老年患者腔镜胆道手术中的应用探讨  

Application of indocyanine green fluorescence imaging in lapascopic biliary tract surgeryamong elderly patients with history of upper abdominal surgery

作　　者：王梽[1] 郑清盛[1] 傅军[1] 梁东 彭帅 吴雪英[1] 何守敏[1] Wang Zhi;Zheng Qingsheng;Fu Jun;Liang Dong;Peng Shuai;Wu Xueying;He Shoumin(Department of general surgery,people's hospital affiliated to Fujian University of Traditional Chinese Medicine,Fuzhou,350004,China)

机构地区：[1]福建中医药大学附属人民医院普外科,福建福州350004

出　　处：《齐齐哈尔医学院学报》2023年第5期469-473,共5页Journal of Qiqihar Medical University

摘　　要：目的探讨吲哚菁绿荧光显像在有上腹部手术史的老年患者腔镜胆道手术中的临床疗效。方法选择2019年6月—2021年12月本院收治的行腹腔镜胆道手术、有上腹手术史的老年胆总管结石患者作为研究对象,随机分为对照组和观察组两组,每组各38例。对照组直接在腹腔镜常规模式下行腹腔镜下胆总管切开取石+T管引流术,观察组皮试阴性后,注射吲哚菁绿,在腹腔镜荧光模式下行该手术。观察比较统计两组各项指标:(1)手术情况:显露胆总管时间、手术时间、术中出血量、中转开腹例数。(2)术后情况:术后肛门排气时间、胆瘘、肠梗阻、心脑血管、肺部并发症、转ICU例数、术后胆总管结石残留例数。(3)血液炎症因子表达情况:分别在术前第1天、术后第1周,抽取并检测病人清晨空腹状态下静脉血,检测白介素-2(IL-2)、白介素-4(IL-4)、白介素-6(IL-6)。结果(1)手术情况:观察组显露胆总管时间、手术时间、术中出血量、中转开腹例数,均少于对照组,差异有统计学意义(P<0.05)。(2)术后情况:观察组肛门排气时间、肠梗阻、心脑血管、肺部并发症、转ICU例数均少于对照组,差异有统计学意义(P<0.05),而两组胆瘘、胆总管结石残留例数,差异无统计学意义(P>0.05)。(3)术前两组血液炎症因子(IL-2、IL-4、IL-6)水平比较,差异无统计学意义(P>0.05)。与术前比较,术后两组IL-2、IL-6水平均显著降低,IL-4水平有所升高(P<0.05)。且观察组上述指标水平与对照组比较,差异有统计学意义(P<0.05)。结论有上腹部手术史的老年患者腔镜胆道手术,采用吲哚菁绿荧光显像明显优于常规模式,可减少机体炎症反应,改善手术及术后各项指标,有利于患者快速康复。Objective To investigate the clinical effect of indocyanine green fluorescence imaging in lapascopic biliary tract surgery among elderly patients with history of upper abdominal surgery.Methods 76 elderly patients with history of upper abdominal surgery,those received lapascopic biliary tract surgery in our hospital during June 2019 and December 2021,were enrolled as study subjects.They were randomly divided into the control group and the observation group,with 38 cases in each group.The control group was directly treated with laparoscopic choledocholithotomy and T-tube drainage under conventional laparoscopic mode.In the observation group,patients were injected with indocyanine green after a negative skin test,and the operation was performed under laparoscopic fluorescence mode.The operation conditions of the two groups were observed and compared:the time of choledocholithotomy,the operation time,intraoperative blood loss,and the number of cases of conversion to laparotomy.Postoperative conditionswere observed and compared:postoperative anal exhaust time,biliary fistula,intestinal obstruction,cardiovascular and cerebrovascular complications,pulmonary complications,ICU transfer cases,postoperative residual choledocholithiasis cases.Expression of blood inflammatory factors:The fasting venous blood of patients was collectedin the morning and detected on the 1 day before surgery and the 1 week after surgery,respectively,to detect interleukin-2(IL-2),interleukin-4(IL-4)and interleukin-6(IL-6).Results The time of common bile duct exposure,operation time,intra-operative blood loss,and the number of cases converted to open surgery in the observation group were significantly less than those in the control group,and the differences were statistically significant(P<0.05).The anal exhaust time in the observation group were shorter than that in the control group;the incidence of intestinal obstruction,cardiovascular and cerebrovascular complications,pulmonary complications,and ICU transfer in the observation group were signi

关 键 词：腹腔镜 胆结石 吲哚菁绿荧光显像 老年患者 上腹部手术史 

分 类 号：R575.6[医药卫生—消化系统]