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腹腔镜胆囊切除术中吲哚菁绿胆道造影精准识别胆总管的应用
DOI: 10.3969/j.issn.1001-5256.2022.01.025
利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。
作者贡献声明：杨君负责课题设计，资料分析，撰写论文；靳浩参与收集数据，修改论文、拟定写作思路，指导撰写文章并最后定稿。
Application of indocyanine green cholangiography in accurate identification of the common bile duct in laparoscopic cholecystectomy
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摘要:
目的 胆总管损伤是腹腔镜胆囊切除术(LC)中的常见并发症。采用吲哚菁绿(ICG)术中显影的方法精准识别胆总管，以期降低腹腔镜胆囊切除术中胆总管损伤的发生率。 方法 纳入珠海市人民医院2021年4月— 6月行LC患者68例，其中行常规LC患者56例，ICG胆道造影引导下LC患者12例。常规LC组患者用腹腔镜白光、ICG胆道造影组用近红外光检查胆总管、胆囊管和胆囊。采用倾向评分匹配法对两组术前数据进行平衡。采用t检验和χ2检验比较两组术中出血量、手术时间、术后住院时间及胆总管损伤发生率。 结果 胆道造影组术中出血量、手术时间、术后住院时间及并发症发生率分别为(3.1±0.9)mL，(20.2±1.6)min，(1.2± 0.3)d和0；明显低于常规组的(10.8±2.3)mL，(48.3±5.1)min，(2.3±0.8)d和8.3%(t值分别为-22.709、-19.856、-19.507，χ2=1.287，P值均＜0.05)。 结论 ICG胆道造影是LC术中鉴别胆总管和胆囊管的有效方法，可有效预防胆总管的损伤。方法胆道辨识度更高、起效时间长、可重复使用、操作方便，并可联合术中导航设备，在应用于胆囊结石患者的治疗中具有明显优势。 -
关键词:
- 胆囊切除术, 腹腔镜 /
- 胆管造影术 /
- 吲哚花青绿
Abstract:Objective To investigate the application of intraoperative indocyanine green (ICG) cholangiography in the accurate identification of the common bile duct since common bile duct injury is a common complication of laparoscopic cholecystectomy (LC), and to reduce the incidence rate of common bile duct injury during LC. Methods A total of 68 patients who underwent LC in Zhuhai People's Hospital from April 2021 to Jane 2021 were enrolled, among whom 56 patients underwent conventional LC and 12 patients underwent LC under the guidance of ICG cholangiography. The common bile duct, cystic duct, and gallbladder were examined by white light laparoscopy for the conventional LC group and near-infrared laparoscopy for the ICG cholangiography group. The propensity score matching method was used to balance the preoperative data between the two groups. The t-test and the chi-square test were used for comparison of intraoperative blood loss, time of operation, length of postoperative hospital stay, and incidence rate of common bile duct injury between the two groups. Results Compared with the conventional LC group, the ICG cholangiography group had significantly lower intraoperative blood loss 3.1±0.9 mL vs 10.8±2.3 mL, t=-22.709, P < 0.05), significantly shorter time of operation (20.2±1.6 min vs 48.3±5.1 min, t=-19.856, P < 0.05) and length of postoperative hospital stay (1.2±0.3 days vs 2.3±0.8 days, t=-19.507, P < 0.05), and a significantly lower incidence rate of complications (0 vs 8.3%, χ2=1.287, P < 0.05). Conclusion ICG cholangiography is an effective method to differentiate between the common bile duct and the cystic duct during LC and can prevent common bile duct injury. This method has great advantages in the treatment of patients with gallstones due to its high degree of identification of the biliary tract, long onset time, repeated application, convenient operation, and ability to be combined with intraoperative navigation device. -
Key words:
- Cholecystectomy, Laparoscopic /
- Cholangiography /
- Indocyanine Green
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注：a、b，荧光及白光下分离胆囊三角周围粘连的过程；c、d，荧光及白光下分离胆囊床及游离胆囊过程；e、f，荧光及白光下结扎胆囊管过程。
图 1 ICG造影引导下腹腔镜胆囊切除术过程
表 1 ICG胆道造影组和常规LC组患者匹配前后基线特征比较
项目 匹配前 匹配后 常规LC组(n=56) ICG胆道造影组(n=12) 标准化差异(%) P值 常规LC组(n=12) ICG胆道造影组(n=12) 标准化差异(%) P值 年龄(岁) 53.2±6.5 63.7±5.1 19.7 0.001 57.1±8.3 57.2±9.6 0.18 0.372 男/女(例) 39/27 8/4 28.3 0.001 8/4 8/4 0 ＞0.05 复杂性胆结石(例) 21 3 33.3 0.006 3 3 0 ＞0.05 
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表 2 ICG胆道造影组和常规LC组患者的手术效果比较
项目 ICG胆道造影组(n=12) 常规LC组(n=12) 统计值 P值 手术时间(min) 20.2±1.6 48.3±5.1 t=-19.856 ＜0.01 术中出血量(mL) 3.1±0.9 10.8±2.3 t=-22.709 ＜0.01 胆总管相关损伤[例(%)] 0 1(8.3) χ2=1.287 0.013 住院时间(d) 1.2±0.3 2.3±0.8 t=-19.507 ＜0.01
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