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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

引用本文:
Citation:

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
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

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

Research funding: 

Guangdong Provincial Medical Science Technological Research Program (A2020360)

  • 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。

     

  • 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。

    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
    常规LC组(n=56) ICG胆道造影组(n=12) 标准化差异(%) P 常规LC组(n=12) ICG胆道造影组(n=12) 标准化差异(%) P
    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
    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
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  • 收稿日期:  2021-05-22
  • 录用日期:  2021-06-10
  • 出版日期:  2022-01-20
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