吲哚菁绿荧光导航在老年急性胆囊炎患者经皮经肝胆囊穿刺引流术后腹腔镜胆囊切除术中的应用

李昌旭; 李学民; 梁占强; 段希斌; 杨鹏生

doi:10.3969/j.issn.1001-5256.2023.04.020

吲哚菁绿荧光导航在老年急性胆囊炎患者经皮经肝胆囊穿刺引流术后腹腔镜胆囊切除术中的应用

DOI: 10.3969/j.issn.1001-5256.2023.04.020

郑州大学附属郑州中心医院肝胆胰外科，郑州 450000

基金项目:

河南省科技攻关项目 (182102310482)

伦理学声明：本研究方案由郑州大学附属郑州中心医院伦理委员会审批，批号为202288。

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：李昌旭负责资料分析，撰写论文，修改论文；梁占强、杨鹏生、段希斌负责提供数据资料及术中图片；李学民负责课题设计，拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
李学民, ztlxm@126.com (ORCD: 0000-0001-7130-2311)

计量
- 文章访问数: 415
- HTML全文浏览量: 57
- PDF下载量: 38
- 被引次数: 0
出版历程
- 收稿日期: 2022-08-31
- 录用日期: 2022-10-17
- 出版日期: 2023-04-20

Application of indocyanine green fluorescence navigation in laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage in elderly patients with acute cholecystitis

Department of Hepatobiliary and Pancreatic Surgery, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou 450000, China

Research funding:

Key Science and Technology Project of Henan Province (182102310482)

More Information

Corresponding author: LI Xuemin, ztlxm@126.com (ORCD: 0000-0001-7130-2311)

摘要

摘要: 目的探讨吲哚菁绿(ICG)荧光导航在老年急性胆囊炎患者经皮经肝胆囊穿刺引流(PTGBD)术后腹腔镜胆囊切除术(LC)中的临床应用价值。方法回顾性收集2021年6月—2022年2月郑州大学附属郑州中心医院老年急性胆囊炎患者PTGBD后行LC的围术期临床资料，术中行ICG荧光导航的患者纳入实验组(n=36)，同期未行ICG荧光导航的患者纳入对照组(n=26)。分析两组患者的术前一般资料，术中明确胆道系统时间、手术时间、术中出血、胆道损伤、中转开腹，术后排气时间、下床活动时间、拔除腹腔引流管时间、恢复正常饮食时间及术后住院时间。计量资料两组间比较采用成组t检验或Mann-Whitney U检验，计数资料组间比较采用χ²检验。结果实验组患者术中明确胆道系统时间[(19.9±3.7) min vs (36.5±5.9)min]、手术时间[(50.6±8.5) min vs (80.9±10.6)min]、术中出血量均少于对照组(t值分别为13.56、12.48，χ²=6.91，P值均＜0.05)。实验组无中转开腹病例，对照组2例中转开腹，两组患者均无胆道损伤。实验组患者术后下床活动时间[(10.2±2.4) h vs (16.6±3.2)h]、拔除引流管时间[(20.1±3.4) h vs (30.7±4.7)h]、恢复正常饮食时间[(20.3±3.8) h vs (31.2±6.0)h]、术后住院时间[3.3(3.0~4.3)d vs 5.3(5.0~6.2)d]均少于对照组(t值分别为8.92、10.20、8.68，Z＝5.91，P值均＜0.05)。结论 ICG荧光导航在老年急性胆囊炎患者PTGBD后LC中使肝外胆道系统可视化，从而有利于精准操作，降低手术风险、缩短手术时间、加快患者术后康复。
- 胆囊炎 /
- 吲哚菁绿 /
- 老年人
Abstract: Objective To investigate the clinical value of indocyanine green (ICG) fluorescence navigation in laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGBD) in elderly patients with acute cholecystitis. Methods A retrospective analysis was performed for the perioperative clinical data of the elderly patients with acute cholecystitis who underwent LC after PTGBD in Zhengzhou Central Hospital Affiliated to Zhengzhou University from June 2021 to February 2022. The 36 patients who underwent ICG fluorescence navigation were enrolled as experimental group, and the 26 patients who did not undergo ICG fluorescence navigation during the same period of time were enrolled as control group. Preoperative general information was analyzed for both groups, as well as time to identify the biliary system during surgery, time of operation, intraoperative blood loss, bile tract injury, conversion to laparotomy, time to first flatus after surgery, time to ambulation, time to removing abdominal drainage tube, time to return to normal diet, and length of postoperative hospital stay. The group t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between groups. Results Compared with the control group, the experimental group had a significantly shorter time to identify the biliary system during surgery (19.9±3.7 min vs 36.5±5.9 min, t=13.56, P < 0.05), a significantly shorter time of operation (50.6±8.5 min vs 80.9±10.6 min, t=12.48, P < 0.05), and a significantly lower amount of intraoperative blood loss (χ²=6.91, P < 0.05). No patient was converted to laparotomy in the experimental group, while 2 patients in the control group were converted to laparotomy, and no bile duct injury was observed in either group. Compared with the control group, the experimental group had significantly shorter time to ambulation (10.2±2.4 hours vs 16.6±3.2 hours, t=8.92, P < 0.05), time to removing abdominal drainage tube (20.1±3.4 hours vs 30.7±4.7 hours, t=10.2, P < 0.05), time to return to normal diet (20.3±3.8 hours vs 31.2±6.0 hours, t=8.68, P < 0.05), and length of postoperative hospital stay [3.3 (3.0-4.3) days vs 5.3 (5.0-6.2) days, Z=5.91, P < 0.05]. Conclusion ICG fluorescence navigation can visualize the extrahepatic biliary system during LC after PTGBD in elderly patients with acute cholecystitis, which may help to achieve accurate operation, reduce the risk of surgery, shorten the time of operation, and accelerate postoperative recovery.
- Cholecystitis /
- Indocyanine Green /
- Aged

HTML全文

图 1 ICG荧光LC术中情况

注：a，胆囊被大网膜包裹；b，显露胆囊；c，确定肝外胆道；d，游离胆囊管；e，确定胆囊管、肝总管、胆总管；f，离断胆囊管。

Figure 1. Intraoperative situation during ICG fluorescent laparoscopic cholecystectomy

下载: 全尺寸图片幻灯片

表 1 患者术前一般资料比较

Table 1. Comparison of preoperative general data between control group and experimental group

项目	对照组(n=26)	实验组(n=36)	统计值	P值
性别(例)			χ²=0.036	0.850
男	10	13
女	16	23
年龄(岁)	67.9±4.7	70.0±3.7	t=1.920	0.059
BMI(kg/m²)	21.2±2.0	20.3±2.3	t=1.638	0.107
高血压(例)	17	26	χ²=0.332	0.564
糖尿病(例)	18	23	χ²=0.192	0.661
冠心病(例)	10	18	χ²=0.812	0.368
PS评分(例)			χ²=1.433	0.231
2分	19	21
3分	7	15
白蛋白(g/L)	33.4±3.1	32.4±2.6	t=1.506	0.137
白细胞(×10⁹/mL)	7.83±1.33	8.34±1.11	t=1.618	0.111
ALT(U/L)	38.5±2.8	39.8±3.2	t=1.651	0.104
AST(U/L)	34.6±2.9	35.7±2.3	t=1.673	0.100
总胆红素(μmol/L)	18.16±2.04	17.29±2.26	t=1.554	0.126
直接胆红素(μmol/L)	5.91±1.04	5.52±1.11	t=1.405	0.165

下载: 导出CSV

表 2 对照组和实验组患者术中资料比较

Table 2. Comparison of intraoperative data between control group and experimental group

组别	例数	明确胆道系统时间(min)	手术时间(min)	术中出血量(例)
组别	例数	明确胆道系统时间(min)	手术时间(min)	＜10 mL	10~50 mL	＞50 mL
对照组	26	36.5±5.9	80.9±10.6	7	11	8
实验组	36	19.9±3.7	50.6±8.5	21	11	4
统计值		t=13.56	t=12.48	χ²=6.91
P值		＜0.001	＜0.001	0.032

下载: 导出CSV

表 3 对照组和实验组患者术后资料比较

Table 3. Comparison of postoperative data between control group and experimental group

组别	例数	排气时间(h)	下床活动时间(h)	拔除引流管时间(h)	恢复正常饮食时间(h)	术后住院时间(d)
对照组	26	14.3±3.7	16.6±3.2	30.7±4.7	31.2±6.0	5.3(5.0~6.2)
实验组	36	13.3±3.2	10.2±2.4	20.1±3.4	20.3±3.8	3.3(3.0~4.3)
统计值		t=1.19	t=8.92	t=10.20	t=8.68	Z=5.91
P值		0.239	＜0.001	＜0.001	＜0.001	＜0.001

下载: 导出CSV

参考文献(15)

[1]	Study Group of Biliary Tract Surgery in Chinese Society of Surgery of Chinese Medical Association, Chinese Medical Doctor Association in Chinese Committee of Biliary Surgeons. Consensus on the surgical management of benign gallbladder diseases (2021 edition)[J]. Chin J Surg, 2022, 60(1): 4-9. DOI: 10.3760/cma.j.cn112139-20210811-00373. 中华医学会外科学分会胆道外科学组, 中国医师协会外科医师分会胆道外科医师委员会. 胆囊良性疾病外科治疗的专家共识(2021版)[J]. 中华外科杂志, 2022, 60(1): 4-9. DOI: 10.3760/cma.j.cn112139-20210811-00373.
[2]	GU YL, YANG SH, FAN Q, et al. The curative effect analysis between emergency and delayed laparoscopic cholecystectomy in treatment of elderly patients with acute calculous cholecystitis[J]. J Laparo Surg, 2018, 23(3): 217-220. DOI: 10.13499/j.cnki.fqjwkzz.2018.03.217. 顾越雷, 杨孙虎, 樊强, 等. 老年人急性结石性胆囊炎行急诊与延期腹腔镜胆囊切除术的疗效分析[J]. 腹腔镜外科杂志, 2018, 23(3): 217-220. DOI: 10.13499/j.cnki.fqjwkzz.2018.03.217.
[3]	WANG GZ, LI T, SHI LG. Choice of timing and modalities of surgery for acute cholecystitis in the elderly[J]. Chin J Gerontol, 2013, 33(6): 1272-1274. DOI: 10.3969/j.issn.1005-9202.2013.06.016. 王庚壮, 李霆, 石利国. 老年急性胆囊炎手术时机和方式的选择[J]. 中国老年学杂志, 2013, 33(6): 1272-1274. DOI: 10.3969/j.issn.1005-9202.2013.06.016.
[4]	GU SN. Modern Biliary Tract Surgery[M]. Shanghai: Fudan University Press, 2017. 顾树南. 现代胆道外科学[M]. 上海: 复旦大学出版社, 2017.
[5]	Biliary Surgery Group of Surgery Branch of Chinese Medical Association. Guidelines for diagnosis and treatment of acute biliary tract infections (2021)[J]. Chin J Surg, 2021, 59(6): 422-429. DOI: 10.3760/cma.j.cn112139-20210421-00180. 中华医学会外科学分会胆道外科学组. 急性胆道系统感染的诊断和治疗指南(2021版)[J]. 中华外科杂志, 2021, 59(6): 422-429. DOI: 10.3760/cma.j.cn112139-20210421-00180.
[6]	XU J, RAO JH, WANG Y. Effects of PTGBD sequential LC on postoperative stress level and gallbladder systolic function in elderly patients with acute and severe cholecystitis[J]. J Clin Exp Med, 2022, 21(8): 803-808. DOI: 10.3969/j.issn.1671-4695.2022.08.006. 许剑, 饶建华, 王玉. 经皮肝穿刺胆囊引流术序贯LC术对老年急重症胆囊炎患者术后应激水平及胆囊收缩功能的影响[J]. 临床和实验医学杂志, 2022, 21(8): 803-808. DOI: 10.3969/j.issn.1671-4695.2022.08.006.
[7]	KARAKAYALI FY, AKDUR A, KIRNAP M, et al. Emergency cholecystectomy vs percutaneous cholecystostomy plus delayed cholecystectomy for patients with acute cholecystitis[J]. Hepatobiliary Pancreat Dis Int, 2014, 13(3): 316-322. DOI: 10.1016/s1499-3872(14)60045-x.
[8]	SONG LM, LI XM, YANG PS. Discussion on the timing of sequential LC for acute cholecystitis after percutaneous transhepatic gallbladder puncture and drainage[J]. Chin J Hepatobiliary Surg, 2021, 27(10): 753-756. DOI: 10.3760/cma.j.cn113884-20210420-00143. 宋黎明, 李学民, 杨鹏生. 经皮经肝胆囊穿刺引流术后序贯行LC治疗急性胆囊炎手术时机的探讨[J]. 中华肝胆外科杂志, 2021, 27(10): 753-756. DOI: 10.3760/cma.j.cn113884-20210420-00143.
[9]	Professional Committee of Minimally Invasive Surgery, Chinese Academy of Research Hospitals; Editorial Department of Journal of Laparoscopic Surgery. Discussion on the application value of indocyanine green fluorescence staining in laparoscopic cholecystectomy[J]. J Laparo Surg, 2019, 24(5): 388-394. DOI: 10.13499/j.cnki.fqjwkzz.2019.05.388. 中国研究型医院学会微创外科学专业委员会, 《腹腔镜外科杂志》编辑部. 吲哚菁绿荧光染色在腹腔镜肝切除术中应用的专家共识[J]. 腹腔镜外科杂志, 2019, 24(5): 388-394. DOI: 10.13499/j.cnki.fqjwkzz.2019.05.388.
[10]	WANG TY, ZHU YF, SUN M, et al. Application of three-dimensional reconstruction combined with indocyanine green intraoperative navigation in diagnosis and treatment of liver cancer[J]. J Jilin Univ(Med Edit), 2021, 47(4): 1014-1021. DOI: 10.13481/j.1671-587X.20210427. 王天一, 朱玉峰, 孙淼, 等. 三维重建联合吲哚菁绿术中导航在肝癌诊断和治疗中的应用[J]. 吉林大学学报(医学版), 2021, 47(4): 1014-1021. DOI: 10.13481/j.1671-587X.20210427.
[11]	LI HY, WEI L, ZHU ZJ, et al. Application value of indocyanine green fluorescence-guided laparoscopic anatomical monosegmentectomy in pediatric living donor liver transplantation[J]. Chin J Dig Surg, 2021, 20(1): 118-124. DOI: 10.3760/cma.j.cn115610-20201028-00679. 李宏宇, 魏林, 朱志军, 等. 吲哚菁绿荧光引导腹腔镜解剖性肝段获取术在小儿活体肝移植中的应用价值[J]. 中华消化外科杂志, 2021, 20(1): 118-124. DOI: 10.3760/cma.j.cn115610-20201028-00679.
[12]	ISHIZAWA T, TAMURA S, MASUDA K, et al. Intraoperative fluorescent cholangiography using indocyanine green: a biliary road map for safe surgery[J]. J Am Coll Surg, 2009, 208(1): e1-e4. DOI: 10.1016/j.jamcollsurg.2008.09.024.
[13]	MITSUHASHI N, KIMURA F, SHIMIZU H, et al. Usefulness of intraoperative fluorescence imaging to evaluate local anatomy in hepatobiliary surgery[J]. J Hepatobiliary Pancreat Surg, 2008, 15(5): 508-514. DOI: 10.1007/s00534-007-1307-5.
[14]	YANG J, JIN H. Application of indocyanine green cholangiography in accurate identification of the common bile duct in laparoscopic cholecystectomy[J]. J Clin Hepatol, 2022, 38(1): 160-163. DOI: 10.3969/j.issn.1001-5256.2022.01.025. 杨君, 靳浩. 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[J]. 临床肝胆病杂志, 2022, 38(1): 160-163. DOI: 10.3969/j.issn.1001-5256.2022.01.025.
[15]	Biliary Surgery Group of Surgery Branch of Chinese Medical Association. Practice guideline for diagnosis and treatment of bile duct injury (2013 edition)[J]. Chin J Dig Surg, 2013, 12(2): 81-95. DOI: 10.3760/cma.j.issn.1673-9752.2013.02.001. 中华医学会外科学分会胆道外科学组. 胆管损伤的诊断和治疗指南(2013版)[J]. 中华消化外科杂志, 2013, 12(2): 81-95. DOI: 10.3760/cma.j.issn.1673-9752.2013.02.001.