切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2024, Vol. 18 ›› Issue (06) : 663 -666. doi: 10.3877/cma.j.issn.1674-3946.2024.06.019

论著

ICG荧光腹腔镜下胆囊切除术的临床应用
王兴1, 文阳辉1, 姚戈冰1, 郭平学1, 杨自华1,()   
  1. 1. 710038 西安,西安医学院第二附属医院肝胆外科
  • 收稿日期:2024-01-05 出版日期:2024-12-26
  • 通信作者: 杨自华

Clinical application of ICG fluorescence laparoscopic cholecystectomy

Xing Wang1, Yanghui Wen1, Gebing Yao1, Pingxue Guo1, Zihua Yang1,()   

  1. 1. Department of Hepatobiliary, the Second Affiliated Hospital of Xi’an Medical College, Xi’an Shaanxi Province 710038, China
  • Received:2024-01-05 Published:2024-12-26
  • Corresponding author: Zihua Yang
  • Supported by:
    Shaanxi Province Key R&D Program Project(2021SF-093)
引用本文:

王兴, 文阳辉, 姚戈冰, 郭平学, 杨自华. ICG荧光腹腔镜下胆囊切除术的临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(06): 663-666.

Xing Wang, Yanghui Wen, Gebing Yao, Pingxue Guo, Zihua Yang. Clinical application of ICG fluorescence laparoscopic cholecystectomy[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(06): 663-666.

目的

探讨吲哚菁绿(ICG)荧光显像引导下的腹腔镜胆囊切除术(LC)对胆囊结石伴胆囊炎患者的影响。

方法

前瞻性纳入2021年1月至2023年1月83例行LC的胆囊结石伴胆囊炎患者作为研究对象。用随机数字表法分为ICG组(n=42例)与常规组(n=41例)。常规组采用LC治疗,ICG组采用ICG荧光显像引导下的LC治疗。数据采用SPSS27.0分析,围手术期指标等计量数据用()描述,采用独立样本t检验;术后并发症等计数资料用[例(%)]表示,行χ2检验。P<0.05为差异有统计学意义。

结果

ICG组第一次探查到胆总管、肝总管,胆囊管均高于常规组[(69.1% vs. 26.8%,59.5% vs. 31.7%),P<0.05];ICG组完全解剖后探查到胆总管、肝总管高于常规组[(90.5% vs. 68.3%,90.5% vs. 85.4%),P<0.05];ICG组患者术中出血量、手术时间、胆囊三角完全解剖所需时间、术后住院时间、胃肠功能恢复时间均短于常规组(P<0.05),两组患者术中胆管损伤率和术后并发症发生率比较,差异无统计学意义(P>0.05)。

结论

ICG荧光显像引导下的腹腔镜胆囊切除术可减轻免疫损伤,提高胆总管、肝总管、胆囊管探查率,减少术中出血量。

Objective

To investigate the effect of indocyanine green (ICG) fluorescence imaging guided laparoscopic cholecystectomy (LC) on patients with gallstones and cholecystitis.

Methods

83 patients with gallstones and cholecystitis who underwent LC from January 2021 to January 2023 were prospectively included as study subjects. They were divided into ICG group (n=42 cases) and conventional group (n=41 cases) by random number table method. The conventional group was treated with LC, and the ICG group was treated with LC guided by ICG fluorescence imaging. Data were analyzed by SPSS27.0, measurement data such as perioperative indicators were described by (), and independent sample t test was used. The statistical data of postoperative complications were expressed with [cases (%)] and Chi-square test was performed. P<0.05 was considered statistically significant.

Results

The first detection of common bile duct, hepatic duct and gallbladder duct in ICG group was higher than that in conventional group [(69.1% vs. 26.8%, 59.5% vs. 31.7%), P<0.05]. After complete dissection, the common bile duct and hepatic duct in ICG group were higher than those in conventional group [(90.5% vs. 68.3%, 90.5% vs. 85.4%), P<0.05]. The amount of intraoperative blood loss, operation time, total dissection time of gallbladder triangle, postoperative hospitalization time and gastrointestinal function recovery time in ICG group were all shorter than those in conventional group (P<0.05). There was no significant difference in the rate of intraoperative bile duct injury and postoperative complications between the two groups (P>0.05).

Conclusion

ICG fluorescence imaging guided laparoscopic cholecystectomy can reduce immune damage, improve the exploration rate of common bile duct, hepatic duct and gallbladder duct, and reduce intraoperative blood loss.

表1 两组患者一般资料比较
表2 两组患者术中探查情况比较[例(%)]
表3 两组患者临床指标比较
表4 两组患者术后并发症比较[例(%)]
[1]
Reddy SJagtap NKalapala R,et al. Choledocholithiasis in acute calculous cholecystitis:guidelines and beyond[J].Ann Gastroenterol202134(2):247-252.
[2]
Vila JJFernández-Urién ICarrascosa J,et al. Management of acute calculous cholecystitis in high risk surgical patients[J].Gastroenterol Hepatol202245(7):574-578.
[3]
Vargheese SNelson TAkhtarkhavari A,et al. Laparoscopic Cholecystectomy in Acute Calculous Cholecystitis:A Secondary Center Experience[J].Cureus202315(6):e41114.
[4]
Valappil MVGulati SChhabra M,et al. Drain in laparoscopic cholecystectomy in acute calculous cholecystitis:a randomised controlled study[J].Postgrad Med J202096(1140):606-609.
[5]
杨健康,周茂旭. 二种手术方法对胆囊合并胆总管结石患者凝血功能及应激反应的影响分析[J/CD].中华普外科手术学杂志(电子版)202014(03):322-324.
[6]
邹浩. 荧光腹腔镜胆囊切除术[J/CD].中华普外科手术学杂志(电子版)202014(03):231.
[7]
皮启飞,殷素鹏,孙乙曾,等. 吲哚菁绿荧光成像技术用于甲状腺全切除术中甲状旁腺血供判断的研究[J].中国普外基础与临床杂志202229(10):1313-1317.
[8]
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202251(17):2984-2987,2992.
[9]
中华消化杂志编辑委员会,中华医学会消化病学分会肝胆疾病协作组,袁耀宗,等. 中国慢性胆囊炎、胆囊结石内科诊疗共识意见(2018年)[J].中华消化杂志201939(02):73-79.
[10]
Ahn HMSon GMLee IY,et al. Optimal ICG dosage of preoperative colonoscopic tattooing for fluorescence-guided laparoscopic colorectal surgery[J].Surg Endosc202236(2):1152-1163.
[11]
Ribero DMento FSega V,et al. ICG-Guided Lymphadenectomy during Surgery for Colon and Rectal Cancer-Interim Analysis of the GREENLIGHT Trial[J].Biomedicines202210(3):541.
[12]
杜金柱,高才植,高允海. 吲哚菁绿荧光显像在复杂腹腔镜胆囊切除术中的初步应用观察[J].中华肝胆外科杂志202026(08):595-599.
[13]
Esposito CSettimi ACerulo M,et al. Efficacy of indocyanine green(ICG)fluorescent cholangiography to improve intra-operative visualization during laparoscopic cholecystectomy in pediatric patients:a comparative study between ICG-guided fluorescence and standard technique[J].Surg Endosc202236(6):4369-4375.
[14]
Bandari MPai MVAcharya A,et al. Anatomical mapping of the biliary tree during laparoscopic cholecystectomy by using indocyanine green dye[J].J Minim Access Surg202218(2):218-223.
[15]
Luo DLiang WMa B,et al. Global trends of indocyanine green fluorescence navigation in laparoscopic cholecystectomy:bibliometrics and knowledge atlas analysis[J].Surg Endosc202236(9):6419-6431.
[1] 唐梅, 周丽, 牛岑月, 周小童, 王倩. ICG荧光导航的腹腔镜肝切除术临床意义[J]. 中华普外科手术学杂志(电子版), 2024, 18(06): 655-658.
[2] 陈燕. LCBDE和ERCP+EST治疗胆囊结石合并胆总管结石的疗效观察[J]. 中华普外科手术学杂志(电子版), 2024, 18(04): 385-388.
[3] 张丹, 蒋童新, 尚培中, 刘凌云, 苗建军. 网膜胆囊腹腔镜切除二例报道[J]. 中华普外科手术学杂志(电子版), 2024, 18(02): 235-236.
[4] 纪凯伦, 郝少龙, 孙海涛, 韩威. 减重术后胆囊结石形成机制的新进展[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 100-103.
[5] 杨雪, 张伟, 尚培中, 宋创业, 尚丹丹, 张蔚. 胆囊十二指肠瘘结石经瘘口排出后自愈一例报道[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 707-708.
[6] 张建波, 东爱华. 不同腹腔镜手术治疗胆囊结石合并胆总管结石的疗效及并发症对比[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 693-696.
[7] 鲁鑫, 许佳怡, 刘洋, 杨琴, 鞠雯雯, 徐缨龙. 早期LC术与PTCD续贯LC术治疗急性胆囊炎对患者肝功能及预后的影响比较[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 648-650.
[8] 王晓梅, 张伟, 尚培中, 张丹. 左位胆囊轴位壶腹腹腔镜切除一例报道[J]. 中华普外科手术学杂志(电子版), 2023, 17(04): 467-468.
[9] 金芳, 尚培中, 蒋童新, 史艳丽, 苗建军. C字形胆囊3点位壶腹腹腔镜切除一例报道[J]. 中华普外科手术学杂志(电子版), 2023, 17(04): 465-466.
[10] 邹瑞, 王一尧, 黄泽鹏, 李铎. 经脐单孔腹腔镜胆囊切除术治疗胆囊结石疗效分析[J]. 中华肝脏外科手术学电子杂志, 2024, 13(03): 334-338.
[11] 孟塬, 巴合提·卡力甫, 马志刚, 王锦国, 张杰, 李玉鹏, 宋巍, 田广磊, 陈雄. 腹腔镜胆囊切除术难度评分系统在急性胆囊炎治疗中的应用价值[J]. 中华肝脏外科手术学电子杂志, 2024, 13(02): 169-175.
[12] 张天献, 吕云福, 郑进方. LC+LCBDE与ERCP/EST+LC治疗胆囊结石合并胆总管结石效果Meta分析[J]. 中华肝脏外科手术学电子杂志, 2024, 13(01): 45-50.
[13] 牛朝, 李波, 张万福, 靳文帝, 王春晓, 李晓刚. 腹腔镜袖状胃切除联合胆囊切除治疗肥胖合并胆囊结石安全性和疗效[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 635-639.
[14] 马建惠, 韩琦, 李韶玲. 加速康复外科护理路径+量化评估对腹腔镜胆囊切除术高龄患者手术室护理满意度的影响[J]. 中华胃食管反流病电子杂志, 2024, 11(01): 53-56.
[15] 李滢旭, 方登华, 沈宗文, 陈熊熊, 熊见武, 杨磊. 完全性内脏转位患者行腹腔镜袖状胃切除术联合胆囊切除术一例(附手术视频)[J]. 中华肥胖与代谢病电子杂志, 2023, 09(04): 299-301.
阅读次数
全文


摘要