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)

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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

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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

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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

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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

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