ICG显像引导在腹腔镜胆囊切除术中的价值

肝脏 ›› 2024, Vol. 29 ›› Issue (10): 1274-1276.

ICG显像引导在腹腔镜胆囊切除术中的价值

赵杰, 周建刚, 杨勇, 邵荣

213161 江苏常州常州市武进中医医院普通外科(赵杰,周建刚,邵荣);213000苏州大学附属第三医院肝胆胰外科(杨勇)

收稿日期:2024-01-03 出版日期:2024-10-31 发布日期:2024-12-02
通讯作者: 邵荣,Email: shaorong000131@163.com
基金资助:
江苏省科学技术厅自然科学基金项目(BK20191153)

The role of ICG imaging guidance in difficult laparoscopic cholecystectomy

ZHAO Jie¹, ZHOU Jian-gang¹, YANG Yong², SHAO Rong¹

1. Department of General Surgery, Changzhou Wujin Hospital of Traditional Chinese Medicine, Jiangsu 213161, China;
2. Department of Hepatobiliary and Pancreatic Surgery, the Third Affiliated Hospital of Suzhou University, Changzhou 213000, China

Received:2024-01-03 Online:2024-10-31 Published:2024-12-02
Contact: SHAO Rong,Email: shaorong000131@163.com

摘要/Abstract

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、(10 125.2±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、(10 859.6±1405.3)元、80.0%,差异均有统计学意义(t=7.590、7.015、6.837、2.557、χ²=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(χ²=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。

关键词: 吲哚青绿, 困难型腹腔镜胆囊切除术

Abstract: 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/χ²=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 (χ²=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.

Key words: Indocyanine green, Difficult laparoscopic cholecystectomy

赵杰, 周建刚, 杨勇, 邵荣. ICG显像引导在腹腔镜胆囊切除术中的价值[J]. 肝脏, 2024, 29(10): 1274-1276.

ZHAO Jie, ZHOU Jian-gang, YANG Yong, SHAO Rong. The role of ICG imaging guidance in difficult laparoscopic cholecystectomy[J]. Chinese Hepatolgy, 2024, 29(10): 1274-1276.

/ 推荐

参考文献

[1] Garzali IU, Aburumman A, Alsardia Y, et al. Is fundus first laparoscopic cholecystectomy a better option than conventional laparoscopic cholecystectomy for difficult cholecystectomy? a systematic review and meta-analysis[J]. Updates Surg, 2022, 74(6): 1797-1803.
[2] Morales-Conde S, Licardie E, Alarcón I, et al. Indocyanine green (icg) fluorescence guide for the use and indications in general surgery: recommendations based on the descriptive review of the literature and the analysis of experience. Cir Esp (Engl Ed), 2022 , 100(9): 534-554.
[3] Wang X, Teh CSC, Ishizawa T, et al. Consensus guidelines for the use of fluorescence imaging in hepatobiliary surgery. Ann Surg, 2021, 274(1): 97-106.
[4] 中华消化杂志编辑委员会. 中国慢性胆囊炎、胆囊结石内科诊疗共识意见(2014年,上海)[J]. 中华消化杂志, 2014, 34(12): 795-799.
[5] Lee DH, Park YH, Kwon OS, et al. Laparoscopic cholecystectomy in patients with previous upper midline abdominal surgery: comparison of laparoscopic cholecystectomy after gastric surgery and non-gastric surgery using propensity score matching[J]. Surg Endosc, 2022, 36(2): 1424-1432.
[6] Ahn HM, Son GM, Lee IY, et al. Optimal icg dosage of preoperative colonoscopic tattooing for fluorescence-guided laparoscopic colorectal surgery. Surg Endosc. 2022, 36(2): 1152-1163.
[7] 陈志, 周荣华, 朱任飞 ,等. 吲哚菁绿荧光成像技术在腹腔镜困难型胆囊切除术中的应用研究[J]. 重庆医学, 2022, 51(17): 2984-2992.
[8] Esposito C, Alberti D, Settimi A, et al. Indocyanine green (icg) fluorescent cholangiography during laparoscopic cholecystectomy using rubina technology: preliminary experience in two pediatric surgery centers[J]. Surg Endosc, 2021, 35(11): 6366-6373.
[9] Badawy A, El-Sayes IA, Sabra T. Image-guided laparoscopic cholecystectomy using indocyanine green fluorescence cholangiography: what is the optimal time of administration? [J]. Minim Invasive Ther Allied Technol, 2022, 31(6): 872-878.
[10] Okada Y, Kawaguchi Y, Matsumura M, et al. A safe sequential treatment approach for patients who have acute cholecystitis with severe inflammation: transmural gallbladder drainage followed by laparoscopic cholecystectomy under the guidance of fluorescence imaging[J]. Asian J Endosc Surg, 2022, 15(1): 230-234.
[11] Quaresima S, Balla A, Palmieri L, et al. Routine near infra-red indocyanine green fluorescent cholangiography versus intraoperative cholangiography during laparoscopic cholecystectomy: a case-matched comparison[J]. Surg Endosc, 2020, 34(5): 1959-1967.
[12] Huang Y, Chen Q, Kuang J, et al. Real-time fluorescent cholangiography with indocyanine green in laparoscopic cholecystectomy: a randomized controlled trial to establish the optimal indocyanine green dose within 30 min preoperatively[J]. Surg Today, 2023, 53(2): 223-231.
[13] Huang H, Du D, Wang Z, et al. Application of Intraoperative fluorescence imaging with indocyanine green in the difficult gallbladder: a comparative study between indocyanine green-guided fluorescence cholangiography and conventional surgery[J]. J Laparoendosc Adv Surg Tech A, 2023, 33(4): 404-410.