吲哚菁绿荧光导航在肝硬化合并HIV感染腹腔镜胆囊切除术中的临床应用OA

Objective To investigate the clinical application value of indocyanine green(ICG)fluorescence navigation in laparoscopic cholecystectomy(LC)for patients with liver cirrhosis complicated by human immunodeficiency virus navigation(HIV)infection.Methods Patients with liver cirrhosis complicated by HIV infection who underwent LC at the Shanghai Public Health Clinical Center from Feburary 2023 to Feburary 2025 were divided into the observation group(n=64)and the control group(n=62),depending on whether ICG fluorescence navigation was utilized during surgery.Basic data,operation time,time to achieve the critical view of safety(CVS),identification of extrahepatic bile ducts,intraoperative blood loss,conversion to open surgery rate,catheterization rate,postoperative hospital stay,bile duct injury,and hematological indicators were compared between the two groups.Results The operation time,CVS achievement time,intraoperative blood loss,conversion to open surgery rate,catheterization rate,catheterization duration,postoperative hospital stay,and incidence of bile duct injury and bile leakage in the observation group were significantly lower than those in the control group(P<0.05).Before dissecting Calot's triangle,the recognition rates of the cystic duct(65.63%vs 41.94%)and common hepatic duct(73.44%vs 45.16%)in the observation group were higher than those in the control group(P<0.05).After dissecting Calot's triangle,the overall recognition rate of extrahepatic bile ducts was significantly improved in the observation group;the recognition rates of the common bile duct(100.00%vs 88.71%),common hepatic duct(100.00%vs 77.42%),and connection between the cystic duct and common bile duct(85.94%vs 53.23%)in the observation group were significantly higher than those in the control group(all P<0.05).There was no significant difference in terms of white blood cell counts or liver function before and after surgery between the two groups(P>0.05).Cellular immunity(absolute CD4+T cell count,CD4+/CD8+T cell ratio)and humoral immunity indicators showed no significant difference between the two groups(P>0.05).No incision infections,poor wound healing,abdominal pain,or jaundice occurred in either group postoperatively.No adverse reactions to ICG were observed in the observation group.Conclusion The use of ICG fluorescence navigation during LC in patients with liver cirrhosis complicated by HIV infection enhances the identification of extrahepatic bile ducts,reduces operation time,and significantly decreases the incidence of iatrogenic bile duct injury.This approach is safe and feasible.