MRCP联合荧光胆道造影在腹腔镜胆囊切除术中识别胆囊床胆管的应用价值  

Application of MRCP combined with fluorescence cholangiography to identify bile duct in gallbladder bed in laparoscopic cholecystectomy

作　　者：王占 贾明光 WANG Zhan;JIA Mingguang(Department of Hepatobiliary Surgery,Zibo Municipal Hospital,Zibo,Shandong 255400,China)

机构地区：[1]淄博市市立医院肝胆外科,山东淄博255400

出　　处：《肝胆胰外科杂志》2024年第9期535-539,共5页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨磁共振胆胰管成像(MRCP)联合吲哚箐绿(ICG)近红外荧光成像胆道造影技术在腹腔镜胆囊切除术(LC)中识别胆囊床胆管的可行性及临床应用价值。方法回顾性分析2021年7月至2023年12月淄博市市立医院术前完善MRCP评估、术中应用荧光胆道造影技术行LC术的160例患者的临床资料(研究组),同时收集2020年1月至2023年12月本院应用传统腹腔镜标准白光模式下行胆囊切除术的180例患者的临床资料(对照组),比较两组患者术中、术后相关指标。结果研究组术中出血量与对照组差异无统计学意义[(10.3±1.7)mL vs(11.9±1.4)mL,P>0.05],手术时间较对照组短[(30.6±10.3)min vs(45.7±9.6)min,P<0.05]。研究组共7.5%(12/160)患者术中荧光胆道造影发现存在胆囊床胆管。研究组出现1例胆囊床胆管损伤,术中给予缝扎,术后无胆漏发生;对照组出现2例胆囊床胆管漏,行内镜逆行胆胰管造影(ERCP)证实。研究组较对照组住院时间短[2.0(1.0,2.0)d vs 3.0(2.0,4.0)d,P<0.05]、置管率较对照组低[2.50%(4/160)vs 8.33%(15/180),P<0.05]。两组术后胆漏发生率、置管时间差异无统计学意义(均P>0.05)。MRCP对诊断胆囊床胆管敏感性为58.3%,特异性为61.0%。结论术前完善MRCP评估,术中应用ICG荧光成像技术有利于胆囊床胆管的发现,可缩短手术时间、提高手术安全性,减少术后并后症发生。Objective To investigate the feasibility and the clinical value of magnetic resonance cholangiopancreatography(MRCP)combined with indocyanine green(ICG)near infrared fluorescence imaging cholangiography in the identification of bile duct in gallbladder bed.Methods The clinical data of 160 patients,who undergwent laparoscopic cholecystectomy(LC)with intraoperative fluorescence cholangiography(the study group)between Jul.2021 and Dec.2023 in Zibo Municipal Hospital,were retrospectively analyzed.Additionally,the clinical data of 180 patients who underwent LC with traditional laparoscopic standard white light mode between Jan.2020 and Dec.2023(control group),were retrospectively collected,and the intraoperative and postoperative indicators between the two groups were compared.Results There was no statistically significant difference in intraoperative blood loss between the two groups[(10.3±1.7)mL vs(11.9±1.4)mL,P>0.05].Operation time in the study group was shorter than that in the control group[(30.6±10.3)min vs(45.7±9.6)min,P<0.05].The bile duct in gallbladder bed was found in 12(7.5%)patients in the study group by intraoperative fluorescence imaging cholangiography.There was 1 case of bile duct injury in gallbladder bed in study group,which was addressed with intraoperative suturing,and bile leakage didn’t occur after surgery.There were 2 cases of duct leakage in gallbladder bed in the control group,which was confirmed by endoscopic retrograde cholangiopancreatography(ERCP).The hospitalization time in the study group was shorter than that in the control group[2.0(1.0,2.0)d vs 3.0(2.0,4.0)d,P<0.05],and the catheterization rate in the study group was lower than that in the control group[2.50%(4/160)vs 8.33%(15/180),P<0.05].There was no statistically significant difference in postoperative biliary leakage incidence rate and catheterization time between the two groups(all P>0.05).The sensitivity and specificity of MRCP for diagnosing the bile duct in gallbladder bed were 58.3%and 61.0%respectively.Conclusion Preo

关 键 词：磁共振胰胆管成像 荧光胆道造影 吲哚菁绿 腹腔镜胆囊切除术 胆囊床胆管 胆漏 

分 类 号：R657.4[医药卫生—外科学]