摘要
目的探讨吲哚菁绿荧光导航在复杂腹腔镜胆囊切除术(LC)中的临床价值。方法回顾性分析2018年7月—2020年8月在鄂东医疗集团黄石市中心医院肝胆胰腺外科收治的96例复杂胆囊结石伴胆囊炎患者行LC的临床资料,按照术前是否静脉注射吲哚菁绿荧光导航分为实验组(n=44)和对照组(n=52),实验组术前7 h经外周静脉注射吲哚菁绿2.5 mg,术中吲哚菁绿荧光导航下行LC。对照组行常规LC。比较两组患者术中胆总管及胆囊管识别率、胆囊三角完全解剖时间、手术时间、术中出血量、胆管损伤情况及术后结石残留率。服从正态分布的计量资料采用均数±标准差(Mean±SD)表示,组间比较采用独立样本t检验,计数资料组间比较采用χ^2检验或Fisher确切概率法。结果两组均成功实施手术,对照组中转开腹1例,无围手术期死亡病例。切开胆囊三角区浆膜前,实验组患者胆总管识别率为84.1%(37/44),胆囊管识别率为72.7%(32/44);对照组患者胆总管识别率为26.9%(14/52),胆囊管识别率为28.8%(15/52),两组患者术前胆总管和胆囊管识别率差异均有统计学意义(P<0.05)。实验组完全解剖胆囊三角时间、手术时间、术中出血量分别为(30.2±8.6)min、(48.2±9.8)min、(16.3±5.2)mL,对照组分别为(46.7±13.9)min、(65.2±15.4)min、(26.1±11.3)mL,两组患者完全解剖胆囊三角、手术时间及术中出血量差异均有统计学意义(P<0.05)。实验组无肝外胆管损伤及结石残留,对照组出现右后肝管损伤1例、胆总管损伤2例、残余胆囊结石1例,两组肝外胆道损伤及术后结石残留率差异无统计学意义(χ^2=3.532,P=0.081)。结论吲哚菁绿荧光导航在复杂LC中有助于早期识别胆总管、胆囊管,可较好地避免术中医源性胆道损伤,具有较好的临床价值。
Objective To investigate the clinical value of indocyanine green(ICG)fluorescence imaging in complex laparoscopic cholecystectomy.Methods The data of 96 patients with complicated gallbladder stones with cholecystitis and cholecystitis who underwent laparoscopic cholecystectomy(LC)from July 2018 to August 2020 in Hepatobiliary and Pancreatic Surgery of Huangshi Central Hospital of Edong Healthcare Group were retrospectively analyzed.Before operation,the patients were divided into experimental group(n=44)and control group(n=52)according to whether indocyanine green was injected intravenously.Seven hours before operation,the experimental group was injected with 2.5 mg indocyanine green,the experimental group underwent LC under guidance of ICG fluorescence imaging technology.The control group underwent conventional LC.The recognition rate of common bile duct and cystic duct,complete anatomy time of gallbladder triangle,operation time,intraoperative blood loss,bile duct injury and residual stone rat were compared.The measurement data obeying normal distribution was expressed by(Mean±SD),and the t test was used comparison between groups,and the chi-square test or Fisher exact probability was used comparison between enumeration data.Results The operation was successfully performed in both groups,In the control group,1 case was converted to laparotomy,There was no perioperative death.Before the incision of the serosa of the triangle of the gallbladder,In the experimental group,the common bile duct recognition rate was 84.1%(37/44),the recognition rate of cystic duct was 72.7%(32/44).In the control group,the common bile duct recognition rate was 26.9%(14/52),the recognition rate of cystic duct was 28.8%(15/52).There were statistically significant differences in the recognition rate of common bile duct and cystic duct between the two groups(P<0.05).In experimental group,the time of complete dissection of gallbladder triangle,the operation time,the intraoperative blood loss were(30.2±8.6)min,(48.2±9.8)min,(16.3±5.2)mL,and(46.7±13.9)min,(65.2±15.4)min,(26.1±11.3)mL in the control group,there were statistically significant difference in the above indicators between experimental group and control group(P<0.05).There was no extrahepatic bile duct injury and residual stones in the experimental group.In the control group,there was 1 case of right posterior hepatic duct injury,2 cases of common bile duct injury and 1 case of residual gallstone.There was no significant difference in extrahepatic bile duct injury and postoperative stone residual rate between the two groups(χ^2=3.532,P=0.081).Conclusion ICG fluorescence navigation is helpful for early identification of common bile duct and cystic duct in laparoscopic complex cholecystectomy,which can avoid iatrogenic bile duct injury and has good clinical value.
作者
彭沙沙
夏国兵
卢奇
Peng Shasha;Xia Guobing;Lu Qi(Department of Hepatobiliary and Pancreatic Surgery,uangshi Central Hospital,Affiliated Hospital of Hubei Polytechnic University,Edong Healthcare Group,Huangshi 435000,China;Hubei Province Key Laboratory of Occupational Hazard Identification ami Control,Wuhan University of Science and Technology,Wuhan 430081,China)
出处
《国际外科学杂志》
2021年第1期19-23,共5页
International Journal of Surgery
基金
湖北省卫生健康科研基金资助(WJ2019H160)。
关键词
胆囊切除术
腹腔镜
荧光
吲哚菁绿
荧光导航
Cholecystectomy,laparoscopic
Fluorescence
Indocyanine green
Fluorescent navigation
