吲哚菁绿荧光导航在日间腹腔镜胆囊切除术中的临床应用价值  

Clinical application value of indocyanine green fluorescence navigation in day-surgery of laparoscopic cholecystectomy

作　　者：俞帆 金丽明 刘杰 尚敏杰 王志敏 魏芳强 YU Fan;JIN Liming;LIU Jie;SHANG Minjie;WANG Zhimin;WEI Fangqiang(Department of Hepatopancreatobiliary and Minimally Invasive Surgery,Zhejiang Provincial People's Hospital/Affiliated People's Hospital of Hangzhou Medical College,Hangzhou 310014,China)

机构地区：[1]杭州医学院附属人民医院/浙江省人民医院肝胆胰外科、微创外科,浙江杭州310014

出　　处：《中国普通外科杂志》2024年第2期236-243,共8页China Journal of General Surgery

基　　金：浙江省基础公益研究计划基金资助项目(LGF21H030011)。

摘　　要：背景与目的:近年来,日间腹腔镜胆囊切除术(DSLC)的开展逐渐增多。由于患者的入院、手术和出院通常在24 h内完成,DSLC对手术安全性和效率有更高的要求。此外,一些超重肥胖患者的内脏脂肪组织过多可能会影响DSLC术中肝外胆道的解剖;吲哚菁绿(ICG)荧光导航可能帮助DSLC术中对胆道结构的识别,进而避免胆道损伤的发生。目前,ICG荧光导航在DSLC术中的应用鲜有报道。因而,本研究探讨ICG荧光导航在DSLC术中的临床应用价值。方法:回顾性分析2021年7月—2023年10月55例在浙江省人民医院接受DSLC的患者的临床资料,根据术中是否应用ICG荧光导航分为荧光手术组(22例)和普通手术组(33例),比较两组患者的一般资料、手术时间、解剖胆囊三角时间、预估出血量以及肝外胆道识别率,并分析超重肥胖(BMI≥24 kg/m2)对肝外胆道识别的影响。结果:荧光手术组与普通手术组的一般资料、超重肥胖患者占比、手术时间、解剖胆囊三角时间和预估手术出血量差异均无统计学意义(均P>0.05);在解剖胆囊三角前,荧光手术组胆囊管识别率、肝总管识别率均明显高于普通手术组(59.1%vs.21.2%,P=0.009;50.0%vs.18.2%,P=0.018);在解剖胆囊三角后,荧光手术组胆总管、肝总管以及胆囊管-胆总管连接处识别率明显高于普通手术组(100.0%vs.69.7%,P=0.004;100.0%vs.33.0%,P<0.0001;86.4%vs.27.3%,P<0.0001);荧光手术组中,在解剖胆囊三角前,超重肥胖患者胆总管识别率明显低于非超重肥胖患者(50.0%vs.92.8%,P=0.039),但在解剖胆囊三角后,两者肝外胆道识别率无明显差异(P>0.05)。荧光手术组与普通手术组超重肥胖间比较结果显示,在解剖胆囊三角前,两组的肝外胆道识别率差异无统计学意义(P>0.05),但在解剖胆囊三角后,荧光手术组的肝总管、胆囊管-胆总管连接处识别率明显高于普通手术组(100.0%vs.25.0%,P=0.001;87.5%vs.16.7%,P=0.005)。结论:DSLC�Background and Aims:In recent years,there has been a gradual increase in the adoption of daysurgery of laparoscopic cholecystectomy(DSLC).Given that patients usually undergo admission,surgery,and discharge within 24 h,DSLC demands higher standards of safety and efficiency.Moreover,excessive visceral fat in some overweight obese patients may affect the anatomical structure of the extrahepatic bile ducts during DSLC.Indocyanine green(ICG)fluorescence navigation may aid in identifying bile duct structures during DSLC,thus preventing bile duct injuries.Currently,there are few reports on the application of ICG fluorescence navigation in DSLC.Therefore,this study was performed to investigate the clinical application value of ICG fluorescence navigation in DSLC.Methods:The clinical data of 55 patients who underwent DSLC in Zhejiang Provincial People's Hospital from July 2021 to October 2023 were retrospectively analyzed.Patients were divided into a fluorescence surgery group(22 cases)and a conventional surgery group(33 cases)based on whether ICG fluorescence navigation was used during operation.The general data,operative time,time for dissection of the Calot's triangle,estimated blood loss,and identification rate of extrahepatic bile ducts were compared between the two groups,and the impact of overweight obesity(BMI≥24 kg/m2)on the identification of extrahepatic bile ducts was also analyzed.Results:There were no significant differences in general data,proportion of overweight obese patients,operative time,time for dissection of the Calot's triangle,and estimated blood loss between the fluorescence surgery group and the conventional surgery group(all P>0.05).Before dissection of the Calot's triangle,the identification rates of the cystic duct and common bile duct in the fluorescence surgery group were significantly higher than those in the conventional surgery group(59.1%vs.21.2%,P=0.009;50.0%vs.18.2%,P=0.018).After dissection of the Calot's triangle,the identification rates of the common bile duct,hepatic duct,and cys

关 键 词：胆囊切除术 腹腔镜 吲哚花青绿 肥胖症 

分 类 号：R657.4[医药卫生—外科学]