摘要
目的:探讨腹腔镜胆囊切除术中应用吲哚菁绿荧光显影肝外胆管对于减少胆管损伤的价值。方法:2023年2月至2023年8月为276例胆囊良性疾病患者由同一手术小组采用同一套手术设备行腹腔镜胆囊切除术。术前6~10 h注射吲哚菁绿2.5 mg进行预处理,术中在白光腹腔镜与荧光腹腔镜两种模式下进行肝外胆管的辨认。比较两种方法对肝外胆管最终辨认的准确例数。结果:276例患者中,荧光模式下对肝总管、胆总管及胆囊管等结构的辨认准确例数为263例,白光模式下为250例,两组差异有统计学意义(P<0.05)。荧光腹腔镜下准确辨认的病例行腹腔镜胆囊切除术,不能准确辨认时行腹腔镜胆囊部分切除或中转开腹。术后随访2个月以上,未发现胆管损伤。结论:腹腔镜胆囊切除术中使用吲哚菁绿荧光显影肝外胆管可增加重要胆管结构的辨认准确度,根据局部解剖辨认情况采取适宜的手术方式可减少胆管损伤风险。
Objective:To investigate the value of using indocyanine green fluorescence to develop extrahepatic bile ducts and reduce the incidence of bile duct injury in laparoscopic cholecystectomy.Methods:Between Feb.2023 and Aug.2023,276 patients with benign gallbladder diseases underwent laparoscopic cholecystectomy by the same surgical group,with the same surgical equipment.P atients were injected with 2.5 mg indocyanine green 6-10 h before surgery for surgical pretreatment.During the operation,the extrahepatic bile ducts were identified using two modes:white light laparoscopy and fluorescence laparoscopy.The accuracy of two methods in i dentifying extrahepatic bile ducts were compared.Results:Among the 276 patients,263 cases were accurately identified for structures such as the common hepatic duct,common bile duct,and cystic duct under fluorescence mode,while 250 cases were accurately identified under white light mode,there was statistically significant difference between the two groups(P<0.05).For cases that could be a ccurately identified under fluorescence laparoscopy,laparoscopic cholecystectomy was performed.For cases couldn't be accurately i dentified under fluorescence laparoscopy,laparoscopic partial cholecystectomy or conversion to open surgery was used.During the identification process,if there was accidental damage of blood vessels or suspicion of damage to the common bile duct,surgery was completed through open surgery.No bile duct injury was found during follow-up for more than 2 months after surgery.Conclusions:Indocyanine green fluorescence in the development of extrahepatic bile duct during laparoscopic cholecystectomy can increase the accuracy of i dentifying important bile duct structures.Adopting appropriate surgical methods based on local anatomical identification can reduce the risk of bile duct injury.
作者
米锋军
姚栋梁
高凯
秦少军
MI Fengjun;YAO Dongliang;GAO Kai(Department of Hepatobiliary Surgery,Shanxi Incaier General Hospital,Yuncheng 044000,China)
出处
《腹腔镜外科杂志》
2024年第4期285-288,307,共5页
Journal of Laparoscopic Surgery
关键词
胆囊切除术
腹腔镜
吲哚菁绿
荧光胆道显影
胆管损伤
Cholecystectomy,laparoscopic
Indocyanine green
Fluorescence biliary tract imaging
Bile duct injury
