吲哚菁绿荧光显影在困难胆囊腹腔镜胆囊切除术中的应用价值

冯其柱; 王思雨; 张超

doi:10.3969/j.issn.1001-5256.2022.11.019

吲哚菁绿荧光显影在困难胆囊腹腔镜胆囊切除术中的应用价值

DOI: 10.3969/j.issn.1001-5256.2022.11.019

冯其柱^{1, 2},
王思雨¹,
张超^1, , ,

1.
安徽医科大学第一附属医院普外科，合肥 230001
2.
安徽理工大学第一附属医院普外科，安徽淮南 232007

基金项目:

安徽高校自然科学研究基金资助重点项目 (KJ2021A0439)

伦理学声明：本研究方案于2021年9月7日经由安徽医科大学第一附属医院医学伦理委员会批准, 批号：2021-15-15，所有患者均签署知情同意书。

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：冯其柱负责课题设计，资料分析，撰写和修改文章；王思雨参与数据收集分析；张超负责拟定写作思路，指导撰写文章。

详细信息

通信作者:
张超，zhangchaolove88@163.com

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出版历程
- 收稿日期: 2022-04-04
- 录用日期: 2022-05-21
- 出版日期: 2022-11-20

Application value of indocyanine green fluorescence imaging in laparoscopic cholecystectomy of difficult gallbladder

Qizhu FENG^{1, 2},
Siyu WANG¹,
Chao ZHANG^{1
, ,
,}

1.
Department of General Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230001, China
2.
Department of General Surgery, First Affiliated Hospital of Anhui University of Science and Technology, Huainan, Anhui 232007, China

Research funding:

Natural Science Foundation of Anhui Universities (KJ2021A0439)

More Information

Corresponding author: ZHANG Chao, zhangchaolove88@163.com(ORCID: 0000-0002-2518-7209)

摘要

摘要: 目的探讨吲哚菁绿(ICG)荧光显影在困难胆囊腹腔镜胆囊切除术(LC)中的应用价值。方法回顾性分析安徽医科大学第一附属医院2021年10月—12月行LC的患者临床资料，根据术中是否使用ICG荧光显影和是否为困难胆囊分为4组：A组为使用ICG荧光显影普通胆囊，B组为使用ICG荧光显影困难胆囊，C组为未使用ICG荧光显影普通胆囊，D组为未使用ICG荧光显影困难胆囊。比较各组手术时间、术中出血、住院时间、住院费用和术后并发症间的差异。正态分布的计量资料2组间比较采用t检验。计数资料2组间比较用χ²检验或Fisher确切概率法。结果 A组与C组相比手术时间、术中出血、住院时间、住院费用和术中并发症，差异均无统计学意义(P值均＞0.05)。B组手术时间和术中出血分别为(75.41±12.96)min和(18.27±6.97)mL，D组分别为(106.78±19.21)min和(23.99±8.43)mL，两组相比差异均有统计学意义(P值均＜0.05)；B组住院时间、住院费用和术后并发症与D组相比，差异均无统计学意义(P值均＞0.05)。结论普通胆囊患者LC术中使用ICG荧光显影优势不明显；但在困难胆囊中，ICG荧光显影有利于胆道显露，可以缩短手术时间，减少术中出血。ZHANG Chao
- 胆囊切除术, 腹腔镜 /
- 吲哚花青绿 /
- 治疗结果
Abstract: Objective To investigate the clinical utility of indocyanine green (ICG) fluorescence imaging in difficult laparoscopic cholecystectomy (LC). Methods The clinical data of LC patients from October 2021 to December 2021 in the First Affiliated Hospital of Anhui Medical University were retrospectively analyzed. Based on whether ICG fluorescence imaging was used and whether gallbladder difficulties were detected, the patients were divided into four groups: ICG common gallbladder (Group A), ICG difficult gallbladder (Group B), common gallbladder (Group C), and difficult gallbladder (Group D). The operative time, intraoperative bleeding, length of hospital stay, hospitalization cost and postoperative complications were compared. Comparison of normally distributed continuous data between groups was performed by t test. Comparison of categorical data between groups was performed using the chi-square test or Fisher's exact probability method. Results The operative time, intraoperative bleeding, length of hospital stay, hospitalization cost and intraoperative complications in group A were comparable to those in Group C (all P > 0.05). The operative time and intraoperative bleeding were (75.41±12.96) min and (18.27±6.97) mL in group B, vs (106.78±19.21) min and (23.99±8.43) mL in group D, respectively, and the differences were statistically significant (all P < 0.05), while the length of hospitalization, hospitalization cost and postoperative complications in group B were comparable to those in group D (all P > 0.05). Conclusion The benefits of ICG fluorescence imaging during LC in patients with the common gallbladder are not obvious. However, in difficult gallbladder cases, ICG fluorescence imaging can improve biliary tract exposure and reduce operation time and intraoperative bleeding.
- Cholecystectomy, Laparoscopic /
- Indocyanine Green /
- Treatment Outcome

HTML全文

图 1 A组白光模式肝外胆管显露清晰

Figure 1. White light mode showed clear extrahepatic bile duct in group A

下载: 全尺寸图片幻灯片

图 2 C组荧光模式肝外胆管染色

Figure 2. Fluorescent mode extrahepatic bile duct staining in group C

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图 3 B组白光模式肝外胆管解剖不清

Figure 3. The anatomy of extrahepatic bile duct in group B with white light was unclear

下载: 全尺寸图片幻灯片

图 4 B组荧光模式肝外胆管显影

Figure 4. Fluorescent-mode extrahepatic bile duct development in group B

下载: 全尺寸图片幻灯片

表 1 患者一般资料比较

Table 1. Comparison of general data of patients

组别	例数	性别(例)		年龄(岁)	合并症 (例)
组别	例数	男	女	年龄(岁)	合并症 (例)
A组	49	18	31	55.29±12.66	13
B组	44	19	25	48.59±14.88	10
C组	45	10	35	52.98±12.76	8
D组	37	16	21	50.95±13.62	10

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表 2 A、C组患者手术相关指标比较

Table 2. Comparison of surgical indicators in group A and C

组别	例数	手术时间(min)	住院时间(d)	术中出血(mL)	住院费用(元)
A组	49	47.16±9.79	2.51±1.00	9.63±2.60	10 163.70±1 040.61
C组	45	49.24±9.45	2.58±1.37	9.49±2.90	9 901.79±1 044.43
t值		1.047	0.274	0.253	1.218
P值		0.298	0.785	0.801	0.226

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表 3 B、D组患者手术相关指标比较

Table 3. Comparison of surgical indicators in group B and D

组别	例数	手术时间(min)	住院时间(d)	术中出血(mL)	住院费用(元)	三孔法/四孔法(例)
B组	44	75.41±12.96	2.82±1.24	18.27±6.97	10 124.12±915.56	30/14
D组	37	106.78±19.21	3.27±1.73	23.99±8.43	10 578.99±1 404.03	15/22
统计值		t=8.729	t=1.366	t=3.300	t=1.691	χ²=6.219
P值		＜0.001	0.176	0.001	0.096	0.013

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