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

杨君; 靳浩

doi:10.3969/j.issn.1001-5256.2022.01.025

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

杨君,
靳浩^,

珠海市人民医院(暨南大学附属珠海医院) 普外二科，广东珠海 519000

基金项目:

广东省医学科学技术研究基金项目 (A2020360)

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。

详细信息

通信作者:
靳浩，986220192@qq.com

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出版历程
- 收稿日期: 2021-05-22
- 录用日期: 2021-06-10
- 出版日期: 2022-01-20

Application of indocyanine green cholangiography in accurate identification of the common bile duct in laparoscopic cholecystectomy

Jun YANG,
Hao JIN^,

Second Department of General Surgery, Zhuhai People's Hospital & Zhuhai Hospital Affiliated to Jinan University, Zhuhai, Guangdong 519000, China

Research funding:

Guangdong Provincial Medical Science Technological Research Program (A2020360)

摘要

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。
- 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.
- Cholecystectomy, Laparoscopic /
- Cholangiography /
- Indocyanine Green

HTML全文

图 1 ICG造影引导下腹腔镜胆囊切除术过程

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。

下载: 全尺寸图片幻灯片

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
项目	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

下载: 导出CSV

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

下载: 导出CSV

参考文献(19)

[1]	ISMAEL HN, COX S, COOPER A, et al. The morbidity and mortality of hepaticojejunostomies for complex bile duct injuries: A multi-institutional analysis of risk factors and outcomes using NSQIP[J]. HPB (Oxford), 2017, 19(4): 352-358. DOI: 10.1016/j.hpb.2016.12.004.
[2]	HALBERT C, PAGKRATIS S, YANG J, et al. Beyond the learning curve: Incidence of bile duct injuries following laparoscopic cholecystectomy normalize to open in the modern era[J]. Surg Endosc, 2016, 30(6): 2239-2243. DOI: 10.1007/s00464-015-4485-2.
[3]	FONG ZV, PITT HA, STRASBERG SM, et al. Diminished survival in patients with bile leak and ductal injury: Management strategy and outcomes[J]. J Am Coll Surg, 2018, 226(4): 568-576. e1. DOI: 10.1016/j.jamcollsurg.2017.12.023.
[4]	BARRETT M, ASBUN HJ, CHIEN HL, et al. Bile duct injury and morbidity following cholecystectomy: A need for improvement[J]. Surg Endosc, 2018, 32(4): 1683-1688. DOI: 10.1007/s00464-017-5847-8.
[5]	MURRAY AC, MARKAR S, MACKENZIE H, et al. An observational study of the timing of surgery, use of laparoscopy and outcomes for acute cholecystitis in the USA and UK[J]. Surg Endosc, 2018, 32(7): 3055-3063. DOI: 10.1007/s00464-017-6016-9.
[6]	KIM SS, DONAHUE TR. Laparoscopic cholecystectomy[J]. JAMA, 2018, 319(17): 1834. DOI: 10.1001/jama.2018.3438.
[7]	TÖRNQVIST B, STRÖMBERG C, AKRE O, et al. Selective intraoperative cholangiography and risk of bile duct injury during cholecystectomy[J]. Br J Surg, 2015, 102(8): 952-958. DOI: 10.1002/bjs.9832.
[8]	MARTINEZ-LOPEZ S, UPASANI V, PANDANABOYANA S, et al. Delayed referral to specialist centre increases morbidity in patients with bile duct injury (BDI) after laparoscopic cholecystectomy (LC)[J]. Int J Surg, 2017, 44: 82-86. DOI: 10.1016/j.ijsu.2017.06.042.
[9]	AYLOO S, SCHWARTZMAN J. Robot-assisted repair of e1 biliary ductal injury with Roux-en-Y hepaticojejunostomy[J]. J Laparoendosc Adv Surg Tech A, 2019, 29(6): 817-819. DOI: 10.1089/lap.2018.0664.
[10]	BOOIJ K, de REUVER PR, van DIEREN S, et al. Long-term impact of bile duct injury on morbidity, mortality, quality of life, and work related limitations[J]. Ann Surg, 2018, 268(1): 143-150. DOI: 10.1097/SLA.0000000000002258.
[11]	DOMINGUEZ-ROSADO I, SANFORD DE, LIU J, et al. Timing of surgical repair after bile duct injury impacts postoperative complications but not anastomotic patency[J]. Ann Surg, 2016, 264(3): 544-553. DOI: 10.1097/SLA.0000000000001868.
[12]	GIULIANOTTI PC, QUADRI P, DURGAM S, et al. Reconstruction/repair of iatrogenic biliary injuries: Is the robot offering a new option? Short clinical report[J]. Ann Surg, 2018, 267(1): e7-e9. DOI: 10.1097/SLA.0000000000002343.
[13]	WYSOCKI AP. Population-based studies should not be used to justify a policy of routine cholangiography to prevent major bile duct injury during laparoscopic cholecystectomy[J]. World J Surg, 2017, 41(1): 82-89. DOI: 10.1007/s00268-016-3665-0.
[14]	JIN H, DONG Q, HE Z, et al. Research on indocyanine green angiography for predicting postoperative hypoparathyroidism[J]. Clin Endocrinol (Oxf), 2019, 90(3): 487-493. DOI: 10.1111/cen.13925.
[15]	JIN H, CUI M. New advances of ICG angiography in parathyroid identification[J]. Endocr Metab Immune Disord Drug Targets, 2019, 19(7): 936-940. DOI: 10.2174/1871530319666190206212456.
[16]	PERRY D, BHARARA M, ARMSTRONG DG, et al. Intraoperative fluorescence vascular angiography: During tibial bypass[J]. J Diabetes Sci Technol, 2012, 6(1): 204-208. DOI: 10.1177/193229681200600125.
[17]	KAWADA K, HASEGAWA S, WADA T, et al. Evaluation of intestinal perfusion by ICG fluorescence imaging in laparoscopic colorectal surgery with DST anastomosis[J]. Surg Endosc, 2017, 31(3): 1061-1069. DOI: 10.1007/s00464-016-5064-x.
[18]	ISHIZAWA T, BANDAI Y, IJICHI M, et al. Fluorescent cholangiography illuminating the biliary tree during laparoscopic cholecystectomy[J]. Br J Surg, 2010, 97(9): 1369-1377. DOI: 10.1002/bjs.7125.
[19]	LIU YY, LIAO CH, DIANA M, et al. Near-infrared cholecystocholangiography with direct intragallbladder indocyanine green injection: Preliminary clinical results[J]. Surg Endosc, 2018, 32(3): 1506-1514. DOI: 10.1007/s00464-017-5838-9.