吲哚菁绿荧光显像技术在腹腔镜再次胆道手术中的应用
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昆明医科大学第二附属医院 肝胆胰外科,云南 昆明 650101

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黄洁,昆明医科大学第二附属医院副主任医师,主要从事肝胆胰外科基础与临床方面的研究。

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云南省科技厅科技计划基金资助项目(202101AT070239)。


Application of indocyanine green fluorescence imaging in laparoscopic reoperation of the biliary tract
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Department of Hepatopancreatobiliary Surgery, the Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China

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    摘要:

    背景和目的:相比于术中胆道造影,吲哚菁绿(ICG)荧光影像技术具有操作方便、术中胆管显像更加清晰优势。国外研究已证实ICG荧光影像技术的可行性及安全性。目前国内关于ICG荧光显像技术应用于腹腔镜下再次胆道手术却鲜有报道。因此,本文报告笔者在腹腔镜再次胆道手术中应用ICG荧光影像技术的初步经验,以评估其临床应用价值。方法 按照纳入与排除标准回顾性收集2020年1月—2022年6月昆明医科大学第二附属医院肝胆胰外科收治的择期行腹腔镜再次胆道手术患者临床资料。将术中采用ICG荧光显像技术的患者作为观察组,术中未采用该技术的患者作为对照组。观察组患者于手术开始前60 min,经肘静脉注射2 mL(总剂量5 mg)ICG注射液,术中利用近红外光三维显像胆管。结果 共纳入184例患者,其中观察组80例,对照组104。观察组胆道ICG荧光影像系统成功率为93.75%(75/80)。观察组的术中平均胆道识别时间明显短于对照组(25 min vs. 39 min,P<0.05),而两组间其他术中指标(手术方式、手术时间、术中出血量、中转开腹率)差异均无统计学意义(均P>0.05)。两组术后通气时间、胆汁漏发生率、术后并发症Clavein-Dindo分级、术后6个月结石复发率均无明显差异(均P>0.05),但观察组术后平均住院时间明显短于对照组(7.13 d vs. 10.35 d,P=0.032)。结论 腹腔镜再次胆道手术中应用ICG荧光显像技术实现胆管系统的可视化,可以避免术中因对胆道系统识别不佳而导致的副损伤。这一技术的应用对再次胆道手术安全有保障,具有良好的应用前景。

    Abstract:

    Background and Aims Compared to intraoperative cholangiography, the indocyanine green (ICG) fluorescence imaging technique offers the advantages of convenient operation and more precise visualization of intraoperative bile ducts. Foreign studies have confirmed the feasibility and safety of the ICG fluorescence imaging technique. However, there are few reports on applying the ICG fluorescence imaging technique in our country's laparoscopic reoperation of the biliary tract. Therefore, this article reports the authors' preliminary experience in applying the ICG fluorescence imaging technique in laparoscopic reoperation of the biliary tract to assess its clinical value.Methods The clinical data of patients who underwent elective reoperation of the biliary tract in the Second Affiliated Hospital of Kunming Medical University from January 2020 to June 2022 were retrospectively collected according to inclusion and exclusion criteria. Patients who underwent the ICG fluorescence imaging technique during surgery were assigned to the observation group, while those who did not receive this technique were assigned to the control group. Patients in the observation group received a 2 mL (total dose 5 mg) intravenous injection of ICG solution 60 min before the start of surgery, and intraoperative three-dimensional imaging of the bile ducts was performed using near-infrared light.Results A total of 184 patients were included, with 80 in the observation group and 104 in the control group. The success rate of the observed bile duct ICG fluorescence imaging system was 93.75% (75/80). The average bile duct identification time during surgery was significantly shorter in the observation group than in the control group (25 min vs. 39 min, P<0.05). In contrast, other intraoperative variables (surgical approach, operative time, intraoperative blood loss, rate of conversion to open surgery) showed no statistically significant differences between the two groups (all P>0.05). The two groups had no significant differences regarding postoperative ventilation time, bile leakage rate, Clavien-Dindo grade of postoperative complications, and stone recurrence rate at 6 months postoperatively (all P>0.05). However, the observation group had a significantly shorter average hospital stay length than the control group (7.13 d vs. 10.35 d, P=0.032).Conclusion The ICG fluorescence imaging technique in laparoscopic reoperation of the biliary tract enables visualization of the biliary system, which can help avoid inadvertent damage due to poor identification of the bile ducts during surgery. This technique ensures safety in reoperative biliary surgery and holds promising potential for clinical application.

    表 2 两组患者既往手术方式、手术次数资料Table 2 The data of the previous operation methods and operation times in the two groups
    图1 研究入组流程图Fig.1 Flow chart of study enrollment
    图2 观察组典型病例术中情况(患者既往行腹腔镜胆肠吻合术,术后2年发现胆肠吻合口结石形成,再次行腹腔镜胆肠吻合术)Fig.2 Intraoperative views of a representative case in the observation group (patient with a history of laparoscopic biliary-intestinal anastomosis, developing anastomotic stone formation 2 years postoperatively, undergoing repeat laparoscopic biliary-intestinal anastomosis)
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黄洁,许丁伟,李新成,李翱,张燕,胡满琴.吲哚菁绿荧光显像技术在腹腔镜再次胆道手术中的应用[J].中国普通外科杂志,2023,32(8):1229-1236.
DOI:10.7659/j. issn.1005-6947.2023.08.011

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  • 收稿日期:2023-04-04
  • 最后修改日期:2023-08-03
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  • 在线发布日期: 2023-09-01