吲哚菁绿荧光显影导航联合改良胰胃吻合应用于腹腔镜保留十二指肠胰头切除术的临床疗效  

Clinical effect of indocyanine green fluorescence navigation combined with modified pancreaticogastrostomy in laparoscopic duodenum-preserving pancreatic head resection

作　　者：张敬坡 刘建华[2] 李赋哲 周新博 李凤山 Zhang Jingpo;Liu Jianhua;Li Fuzhe;Zhou Xinbo;Li Fengshan(Department of Hepatobiliary and Pancreatic Surgery,the First Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Hepatobiliary Surgery,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Critical Medicine,the First Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第一医院肝胆胰外科,石家庄050000 [2]河北医科大学第二医院肝胆外科,石家庄050000 [3]河北医科大学第一医院重症医学科,石家庄050000

出　　处：《中华肝胆外科杂志》2024年第3期197-201,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨吲哚菁绿荧光显影导航联合改良胰胃吻合应用于腹腔镜保留十二指肠胰头切除术(LDPPHR)的可行性、安全性及疗效。方法回顾性分析河北医科大学第一医院肝胆胰外科2019年1月至2022年1月接受吲哚菁绿荧光显影导航联合改良胰胃吻合的LDPPHR治疗的14例患者临床资料,其中男性4例,女性10例,年龄(40.6±7.1)岁。记录患者手术时间、术中出血量、术后并发症及随访情况。结果14例患者均顺利完成手术,围手术期无吲哚菁绿过敏反应,术中吲哚菁绿染色显影胆总管效果良好。手术时间(325.71±23.00)min,其中胰胃吻合时间(18.32±1.52)min。术中出血200(150,300)ml,无术中输血。术后发生A级胰瘘3例、胆瘘1例、胆道狭窄1例。全部患者均获得随访,随访1~18个月,中位随访时间10个月。1例患者术后间断发热,于术后1月门诊复查磁共振胰胆管造影提示胆道狭窄,再次入院后经内镜下胆道支架置入治疗痊愈出院。结论吲哚菁绿荧光显影导航技术辅助LDPPHR安全、可行,联合改良胰胃吻合减少了空肠吻合步骤,有效提升了手术效能。Objective To evaluate the feasibility,safety and efficacy of indocyanine green(ICG)fluorescence imaging navigation combined with modified pancreaticogastrostomy in laparoscopic duodenum-preserving pancreatic head resection.Methods The clinical data of 14 patients undergoing laparoscopic duodenum-preserving pancreatic head resection with indocyanine green fluorescence navigation technique combined with modified pancreaticogastrostomy from January 2019 to January 2022 in the Department of Hepatobiliary and Pancreatic Surgery,the First Hospital of Hebei Medical University were retrospectively analyzed,including 4 males and 10 females,aged(40.6±7.1)years.The operation time,intraoperative blood loss,postoperative complications and follow-up were recorded.Results All 14 operations were successfully completed,and there was no intraoperative ICG allergic reaction.The intraoperative ICG staining facilitated the identification of common bile duct.The operation time was(325.71±23.00)min,and the time of modified pancreaticogastrostomy was(18.32±1.52)min.Intraoperative blood loss was 200(150,300)ml.There were no case of intraoperative blood transfusion.Postoperative complications include three cases of grade A pancreatic fistula,one of biliary fistula,and one of biliary stricture.All patients were followed up for one to 18 months,and the median follow-up time was 10 months.One patient had intermittent fever after operation.Magnetic resonance cholangiopancreatography showed biliary stricture in one patient one month after operation,which was managed by endoscopic biliary stent implantation.Conclusion Indocyanine green fluorescence navigation is safe and feasible in laparoscopic duodenum-preserving pancreatic head resection.Combined with modified pancreaticogastrostomy,it helps skip the jejunal anastomosis and improve the efficiency of surgery.

关 键 词：胰腺肿瘤 腹腔镜检查 保留十二指肠胰头切除术 吲哚菁绿 荧光显影技术 胰胃吻合 

分 类 号：R657.5[医药卫生—外科学]