The study investigated the clinical value of fluorescence cholangiography using indocyanine green (ICG) in laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) in preventing bile duct injury (BDI) and detecting bile leakage. A total of 300 patients who underwent fluorescent navigation LC and LCBDE in the Second Department of General Surgery, Shengjing Hospital Affiliated to China Medical University from June 2020 to September 2022 were selected as the research objects for observation and analysis. There were 114 males and 186 females, and aged (50.7±14.0) years with the body mass index (BMI) of (23.6±1.6) kg/m². All 300 cases of fluorescence navigation surgery were successfully completed, of which 5 patients received fluorescence-guided LCBDE and primary suture. The results showed that the application of fluorescence cholangiography with ICG can effectively avoid and detect the occurrence of BDI and bile leakage. Meanwhile, it is reasonable to hypothesize that ICG can be used for rapid localization and the final check to prevent the recurrence of bile leakage when bile leakage is suspected in the second operation.

吲哚菁绿(indocyanine green,ICG)荧光胆道造影是可以无创显示肝外胆道并能提示胆漏[1].笔者参与完成1例胆囊结石合并胆道解剖异常的腹腔镜胆囊切除术(LC),术前经静脉注射联合术中经引流管注射ICG荧光胆道造影,有效避免术中胆道损伤,总结报告如下.

目的 探讨LC术中经静脉注射吲哚菁绿(indocyaninegreen,ICG)的最佳给药剂量.方法 回顾性收集2020年6月至11月中国医科大学附属盛京医院第二普通外科收治的行荧光导航LC的40例患者临床资料,患者通过信封法随机平分至ICG剂量为0.125 mg、0.250 mg、0.500 mg、1.000 mg四组中,观察患者肝外胆管显影时间及显影率、荧光强度及荧光强度对比值.结果 随着给药剂量的增加,肝脏背景荧光强度亦明显增加;给药20 min时,0.125 mg组、0.250 mg组胆囊管-胆总管(CD-CBD)连接处荧光强度仍较低[(64.149±58.808)vs(101.495±58.247)],0.500 mg组、1.000 mg组CD-CBD连接处荧光强度则相对较高[(160.033±31.835)vs 167.678±43.101)].此外,0.125 mg组显影时间较长,4组间肝脏[(92±29)s vs(53±30)s vs(33±12)s vs(31±11)s,F=15.500,P<0.05)、CD-CBD连接处[(933±101)s vs(755±123)s vs(771±111)s vs(767±110)s,F=3.695,P<0.05)显影时间具有统计学差异.4组间给药20 min时CD-CBD连接处显影率具有统计学差异(60％vs 80％vs 100％vs 100％,χ2=7.157,P<0.05);0.500 mg组、1.000 mg组给药20 min时CD-CBD连接处完全显影,且15 min时0.500 mg组荧光强度对比值优于1.000 mg组[-0.058(-0.082,0.057)vs-0.223(-0.362,-0.038),H=3.863,P<0.05].术中荧光效果评价调查显示,60％的医师认为0.500 mg ICG是最佳术中静脉注射剂量,90％的医师认可术中经静脉注射ICG的有效性.结论 LC术中经静脉注射ICG 0.500 mg,即可达到满意的荧光效果,可满足LC绝大多数情况下的荧光需求.该方案可常规应用于荧光导航LC中,存在粘连或胆囊三角脂肪堆积严重时,可酌情增加ICG剂量.

背景与目的:腹腔镜胆囊切除术(LC)中经胆道直接注射吲哚菁绿(ICG)行荧光胆管显影,有即刻显影及零肝脏背景荧光的优势,在复杂LC中有更好的效果.本研究旨在探讨经皮经肝胆囊穿刺引流术(PTGBD)或经内镜鼻胆管引流术(ENBD)术后行荧光LC的临床效果.方法:选取2019年1月-2021年4月120例行LC的胆囊结石患者的临床资料,在经PTGBD或ENBD术后60例行注射ICG荧光导航的LC(观察组),60例行普通白光LC(对照组).比较两组患者的肝外胆管显示率及相关临床指标.结果:两组患者的术前一般资料差异无统计学意义(均P＞0.05).解剖胆囊三角前,观察组的肝总管、胆总管、胆囊管、胆囊管胆总管汇合部及胆囊颈部显示率明显高于对照组(均P＜0.05),但两组的右肝管显示率差异无统计学意义(P＞0.05);解剖胆囊三角后,观察组的肝总管、胆总管及胆囊管胆总管汇合部显示率明显高于对照组(均P＜0.05).与对照组比较,观察组患者手术用时缩短、术中出血量减少,肝下引流管放置率降低,术后住院时间缩短(均P＜0.05).两组的住院费用、并发症发生率差异无统计学意义(均P＞0.05).结论:荧光导航LC的运用有利于提高肝外胆管的显示率,降低PTGBD及ENBD术后复杂LC的难度,缩短手术时间及住院时间,减少术中出血量及肝下引流管留置.

Objective:To analyze the optimal preoperative timing of indocyanine green administration to do the fluorescence imaging during laparoscopic cholecystectomy.Methods:A total of 102 patients with laparoscopic cholecystectomy from January 2019 to November 2019 were retrospectively analyzed in this study, including 42 male patients and 60 female patients with an average age of 49(15-87) years old. The preoperative timing of indocyanine green (2.5 mg/ml, 1 ml) administration was set at 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, and 12 h before surgery, 12, 7, 8, 6, 6, 7, 8, 10, 8, 8, 8, 7, 7 patients, respectively. The intraoperative fluorescence imaging and signal contrast were compared.Results:Comparing with 0.5h group, the liver fluorescence intensities in 5, 6, 7, 8, 9, 10, 11 and12 h groups were significantly decreased (all P<0.05). There were no differences in the fluorescence intensities of the gallbladder, gallbladder duct, common bile duct and common liver duct between those groups with different injection timepoints (all P>0.05), and signal contrast was significantly lower in 0.5 h group than patients in 6, 7, 8, 9, 10, 11 and 12 h groups (all P<0.05). When preoperative timing of indocyanine green administration was 7 h, the fluorescence signal contrast reached the highest values of 0.29. Conclusions:The optimal preoperative timing of indocyanine green intravenous administration for laparoscopic cholecystectomy under fluorescence navigation was 7 h at dose 2.5 mg.