吲哚菁绿荧光显影在Mirizzi综合征Ⅱ~Ⅲ型患者腹腔镜胆囊切除术中的应用分析  

The application of indocyanine green fluorescence imaging in laparoscopic cholecystectomy for Mirizzi syndrome typesⅡandⅢ

作　　者：杜金柱 高允海[1] 朴明姬[1] 衣凯 高才植 Du Jinzhu;Gao Yunhai;Piao Mingji;Yi Kai;Gao Caizhi(Department of General Surgery,Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang 110032,China;Department of Endoscopy,Fushun Central Hospital,Fushun 113006,China)

机构地区：[1]辽宁中医药大学附属医院普外科,沈阳110032 [2]抚顺市中心医院内镜科,抚顺113006

出　　处：《中华肝胆外科杂志》2024年第3期180-183,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：辽宁省科学技术计划项目(2021JH2/1030003)。

摘　　要：目的分析吲哚菁绿荧光显影应用于Mirizzi综合征Ⅱ~Ⅲ型患者腹腔镜胆囊切除术(LC)中的临床价值。方法回顾分析辽宁中医药大学附属医院2018年10月至2022年2月收治的80例行LC的CsendesⅡ~Ⅲ型Mirizzi综合征患者资料,其中男性32例,女性48例,年龄(63.5±6.9)岁。80例患者中应用吲哚菁绿荧光腹腔镜的患者纳入观察组(n=42),使用腹腔镜白光纳入对照组(n=38)。观察组行LC时通过吲哚菁绿荧光显影识别肝外胆管系统,术中注射吲哚菁绿判断预留胆囊瓣血运,确定切除线。比较两组手术时间、术中出血量、中转开腹率及术后并发症(胆漏、切口感染等),分析观察组术中荧光显影和判断预留胆囊瓣血运更改切除线情况。结果两组患者年龄、男性比例、Mirizzi综合征分型、中转开腹率等比较,差异均无统计学意义(均P>0.05)。观察组手术时间为(208.7±32.0)min、术中出血量为(50.5±23.8)ml、胆漏为7.1%(3/42),低于对照组的(228.2±33.9)min、(73.8±31.0)ml、26.3%(10/38),差异均有统计学意义(均P<0.05)。观察组42例患者中37例(88.1%)胆总管、肝总管吲哚菁绿显影。观察组经吲哚菁绿荧光显影判断胆囊瓣血运后,8例(19.0%)更改手术切除线,切除荧光无显影胆囊瓣。结论Mirizzi综合征行LC术中利用吲哚菁绿荧光显影,可以显影胆总管、肝总管引导手术切除,判断胆囊瓣血运确定切除线,减少术后胆漏和出血,加快手术进度。Objective To analyze the clinical value of indocyanine green(ICC)fluorescence imaging in Mirizzi syndrome typeⅡ-Ⅲlaparoscopic cholecystectomy(LC).Methods A retrospective analysis was performed on 80 patients diagnosed with Mirizzi syndrome typesⅡ-Ⅲwho underdoing LC in Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from October 2018 to February 2022,including 32 males and 48 females,aged(63.5±6.9)years.Patients were divided into two groups based on whether ICG fluorescence imaging technology was used,the control group(n=38)that patients were treated with conventional LC and the experimental group(n=42)patients were treated with LC guided by ICG fluorescence imaging.In the experimental group,the extrahepatic bile duct was identified by ICG fluorescence imaging during LC,and ICG was injected intraoperally to determine the reserved blood flow of gallbladder flap for fluorescence imaging and determine the resection line.Operation time,intraoperative blood loss,conversion rate of laparotomy and postoperative complications(bile leakage,incision infection,etc.)were compared between the two groups.Intraoperative fluorescence imaging and determination of the modified resection line of reserved gallbladder were analyzed in the observation group.Results There was no significant difference in age,male proportion,type of Mirizzi syndrome and conversion rate of laparotomy between the two groups(all P>0.05).In the observation group,the operative time was(208.7±32.0)min,the intraoperative blood loss was(50.5±23.8)ml,and the biliary leakage was 7.1%(3/42),which was lower than that in the control group(228.2±33.9)min,(73.8±31.0)ml,26.3%(10/38).The differences were statistically significant(all P<0.05).Of 37 cases(88%)showed common hepatic duct and common bile duct successfully in the observation group.In the observation group,ICG fluorescence imaging was used to determine the gallbladder resection line in 8 cases(19.0%).The gallbladder flap without fluorescence imaging was removed.Conclusion

关 键 词：MIRIZZI综合征 胆囊切除术 腹腔镜 吲哚菁绿荧光显影 胆漏 

分 类 号：R657.4[医药卫生—外科学]