经胆囊注射吲哚菁绿在腹腔镜困难型胆囊切除术中的应用  

Application of indocyanine green injected into gallbladder in laparoscopic complicated cholecystectomy

作　　者：陈志 吴宏匀 朱国栋[3] 朱任飞[3,4] CHEN Zhi;WU Hongyun;ZHU Guodong;ZHU Renfei(Department of General Surgery,Rugao Hospital of Traditional Chinese Medicine,Nantong,Jiangsu 226500,China;Department of Ultrasound,Rugao Hospital of Traditional Chinese Medicine,Nantong,Jiangsu 226500,China;Department of Hepatobiliary Surgery,Nantong Third People’s Hospital,Rugao,Jiangsu 226000,China;Hepatobiliary Center,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]如皋市中医院普外科,江苏如皋226500 [2]如皋市中医院超声科,江苏如皋226500 [3]南通大学附属南通市第三人民医院肝胆外科,江苏南通226000 [4]南京医科大学第一附属医院肝胆中心,江苏南京210000

出　　处：《肝胆胰外科杂志》2023年第9期530-535,共6页Journal of Hepatopancreatobiliary Surgery

基　　金：南通市基础科学研究和社会民生科技计划项目(通科资[2022]93号);如皋市指令性科技攻关计划项目(皋科发[2023]1号)。

摘　　要：目的 探讨在腹腔镜胆囊切除术(LC)中采取经胆囊注射吲哚菁绿(ICG)近红外线胆道成像(NIRC)技术用于治疗困难型胆囊的可行性及疗效。方法 回顾性分析2019年6月至2022年5月在如皋市中医院普外科及南通市第三人民医院肝胆外科行LC治疗的困难型胆囊患者的病例资料。其中对照组(n=34)在白光模式下行常规LC手术,ICG组(n=34)在术中将胆汁与ICG混合后注入胆囊腔,然后在荧光模式下行LC。结果 两组均成功实施LC手术,ICG组均成功实施荧光成像。ICG组三管识别时间[(14.81±3.23)min vs (29.37±2.38)min,t=-18.52,P<0.001]、手术时间[(45.18±3.44)min vs (59.24±4.17)min,t=-11.26,P<0.001]、术后引流时间[(2.52±0.44)d vs (3.37±0.51)d,t=-7.67,P<0.001]、术后住院时间[(3.14±0.63)d vs (4.67±0.39)d,t=-7.81,P<0.001]均较对照组短,术中出血量较对照组少[(15.46±6.25)mL vs (25.76±4.23)mL,t=-6.45,P<0.001],差异均具有统计学意义。对照组1例因胆囊三角致密粘连、胆囊动脉损伤而中转开腹手术,2例发生胆囊管损伤;ICG组未见术中副损伤;两组术中副损伤差异无统计学意义[0 vs 8.8%(3/34),P=0.16]。术后第2天ICG组ALT、AST、TBIL均低于对照组,差异均有统计学意义(P<0.05)。结论 困难型胆囊患者LC术中经胆囊注射吲哚菁绿显影简单易行,可在困难型胆囊术中显示胆囊及胆管结构,有助于安全高效解剖肝外胆管及胆囊床的同时加快手术进度,减少手术创伤。Objective To investigate the feasibility and effeciency of indocyanine green(ICG)near-infrared cholangiography(NIRC)imaging technique in laparoscopic cholecystectomy for difficult gallbladder.Methods A retrospective analysis was conducted on the clinical data of difficult gallbladder patients treated with LC in Rugao Hospital of Traditional Chinese Medicine and Nantong Third People’s Hospital between Jun.2019 and May 2022.In the control group(n=34),routine LC was performed under white-light mode,while in the ICG group(n=34),the mixture of bile and ICG was injected into the gallbladder cavity,and then LC was performed under fluorescence mode.Results LC was successfully performed in both groups.And fluorescence imaging was successfully performed in ICG group.Compared with the control group,the ICG group had shorter three-tube identification time[(14.8±3.2)min vs(29.4±2.4)min,t=-18.52,P<0.001],operation time[(45.18±3.44)min vs(59.24±4.17)min,t=-11.26,P<0.001],postoperative drainage time[(2.52±0.44)d vs(3.37±0.51)d,t=-7.67,P<0.001]and postoperative hospitalization time[(3.1±0.6)d vs(4.7±0.4)d,t=-7.81,P<0.001],and less intraoperative blood loss[(15.5±6.3)mL vs(25.8±4.2)mL,t=-6.45,P<0.001].In the control group,1 patient was converted to open cholecystectomy because of dense adhesion of the Calot triangle and injury of the cystic artery,and 2 cases had injury of the cystic duct;while no intraoperative injury was found in the ICG group.There was no statistical difference between the two groups on intraoperative injury[8.8%(3/34)vs 0,P=0.16].On the 2nd day postoperative,the levels of ALT,AST and TBIL in ICG group were significantly lower than those in control group(P<0.05).Conclusion For patients with difficult gallbladder,indocyanine green injecting into gallbladder during LC is simple and feasible,which can display the structure of gallbladder and bile duct,which is helpful to dissect the extrahepatic bile duct and gallbladder bed safely and efficiently,which can speed up the operation progress,reduce the su

关 键 词：困难型胆囊 腹腔镜胆囊切除术 吲哚菁绿 近红外胆道成像 

分 类 号：R657.4[医药卫生—外科学]