ICG显像引导在腹腔镜胆囊切除术中的价值  

The role of ICG imaging guidance in difficult laparoscopic cholecystectomy

作　　者：赵杰[1] 周建刚[1] 杨勇[2] 邵荣[1] ZHAO Jie;ZHOU Jian-gang;YANG Yong;SHAO Rong(Department of General Surgery,Changzhou Wujin Hospital of Traditional Chinese Medicine,Jiangsu 213161,China;Department of Hepatobiliary and Pancreatic Surgery,the Third Affiliated Hospital of Suzhou University,Changzhou 213000,China)

机构地区：[1]常州市武进中医医院普通外科,江苏常州213161 [2]苏州大学附属第三医院肝胆胰外科,213000

出　　处：《肝脏》2024年第10期1274-1276,1280,共4页Chinese Hepatology

基　　金：江苏省科学技术厅自然科学基金项目(BK20191153)。

摘　　要：目的分析吲哚青绿(ICG)显像引导在腹腔镜胆囊切除术中的价值。方法纳入2022年5月至2023年5月收治的腹腔镜胆囊切除术患者60例,其中使用白光模式肝外胆管显影25例,用ICG模式肝外胆管显影35例,比较两组临床指标和并发症发生率。结果ICG组的手术时间、术中出血量、住院时间、住院费用、三孔腹腔镜胆囊切除术占比分别为(75.1±12.8)min、(17.6±6.6)mL、(2.8±1.2)d、(10125.2±902.3)元、28.6%,均低于白光组(105.6±18.9)min、(23.7±8.6)mL、(3.6±1.8)d、(10859.6±1405.3)元、80.0%,差异均有统计学意义(t=7.590、7.015、6.837、2.557、χ^(2)=15.429,均P<0.05)。术后ICG组发生出血、肺部感染、胆瘘、胆管损伤分别为0、1、0及0例,白光组分别为1例、2例、1例及2例。两组并发症总发生率比较,差异有统计学意义(χ^(2)=6.326,P=0.012)。结论ICG的荧光成像可清晰显示胆管结构,有助于缩短手术时间和术中出血量,避免胆管损伤。Objective To evaluate the clinical utility of indocyanine green(ICG)fluorescence imaging guidance in facilitating difficult laparoscopic cholecystectomy.Methods A total of 60 patients undergoing difficult laparoscopic cholecystectomy were enrolled between May 2022 and May 2023,comprising 35 males and 25 females,with a mean age of 53.6±2.1 years.The patients were divided into two groups based on the use of ICG imaging guidance during surgery:the observation group(n=35)utilized ICG fluorescence imaging for extrahepatic bile duct visualization,while the control group(n=25)used standard white light imaging.Clinical outcomes and complication rates between the two groups were compared.Results In the observation group,the operating time,intraoperative blood loss,hospital stay,hospital cost,and percentage of four-port laparoscopic cholecystectomy were 75.1±12.8 minutes,17.6±6.6 mL,2.8±1.2 days,￥10,125.2±902.3,and 28.6%,respectively.These values were significantly lower than those in the control group,which were105.6±18.9 minutes,23.7±8.6 mL,3.6±1.8 days,￥10859.6±1405.3,and 80.0%(t/χ^(2)=7.590、7.015、6.837、2.557 and 15.429,respectively;P<0.05).The incidence of bleeding,pulmonary infection,biliary fistula and bile duct injury in the observation group was 0(0%),1 case(2.9%),0(0%)and 0(0%)respectively,compared to 1 case(4.0%),2 cases(8.0%)and 1 case(4.0%)in the control group.The total complication rate between the two groups was statistically significant(χ^(2)=6.326,P=0.012).Conclusion Difficult laparoscopic cholecystectomy poses a higher risk of bile duct injury due to unclear anatomical structures and anatomical variationss.ICG fluorescence imaging significantly enhances the visualization of bile duct structures,reduces operation time and intraoperative blood loss,helps prevent bile duct injury and decreases postoperative complications.Therefore,it is a valuable technique that merits wider adoption in clinical practice.

关 键 词：吲哚青绿 困难型腹腔镜胆囊切除术 

分 类 号：R657.4[医药卫生—外科学]