超低固定剂量吲哚菁绿荧光导航技术在腹腔镜困难胆囊切除术中的临床应用OA
Clinical application of ultra-low fixed dose indocyanine green fluorescence navigation technology in laparoscopic difficult cholecystectomy
目的 探讨超低固定剂量吲哚菁绿(ICG)荧光导航技术在困难腹腔镜胆囊切除术(LC)中的临床应用价值.方法 回顾性分析2024年1月至2025年1月仙居县人民医院肝胆外科单个医疗组收治的134例接受困难LC术的患者临床资料.根据是否实施ICG荧光导航,本研究将患者分为ICG组[LC术前外周静脉注射ICG(0.05 mg/mL,1 mL),n=77]与对照组(常规LC术,n=57).比较两组患者手术过程中三管(胆囊管、肝总管、胆总管)辨识的时间、手术时间、术中出血量、术中放置引流管率、术中胆管损伤(BDI)发生率、术后拔管时间、术后并发症发生率、术后住院时间、总住院费用,术前及术后第1天白细胞(WBC)计数、C反应蛋白(CRP)、丙氨酸氨基转移酶(ALT)、γ-谷氨酰基转移酶(GGT)水平的差异.结果 与对照组比较,ICG组三管辨识的时间明显缩短[(30.4±13.9)min vs(38.4±12.9)min]、术中出血量明显减少[(17.4±10.0)mL vs(21.6±11.7)mL]、手术时间[(56.9±19.6)min vs(64.0±16.9)min]以及术后住院时间[2(2,3)d vs 3(3,4)d]明显缩短,差异均具有统计学意义(P<0.05).两组患者在术中放置引流管率,术中BDI发生率,术后第1天WBC、CRP、ALT、GGT水平,术后拔管时间,术后并发症发生率,总住院费用等方面比较,差异均无统计学意义(P>0.05).结论 超低固定剂量ICG荧光导航技术在困难LC中的应用安全可行,可提高三管辨识率,减少术中出血量,缩短手术时间及术后住院时间.
Objective To investigate the application value of ultra-low fixed dose indocyanine green(ICG)fluorescence navigation technology in laparoscopic difficult cholecystectomy.Methods A retrospective analysis was performed on the clinical data of 134 patients who underwent laparoscopic difficult cholecystectomy in Xianju People's Hospital by a single medical team between January 2024 and January 2025.Depending on whether ICG fluorescence navigation was implemented,134 patients were divided into the ICG group[n=77,preoperative peripheral intravenous injection of ICG(0.05 mg/mL,1 mL)]and the control group(n=57,conventional laparoscopic cholecystectomy).Time to distinguish the three ducts(cystic duct,common hepatic duct,common bile duct),operation time,intraoperative blood loss,intraoperative drainage tube placement,intraoperative bile duct injury,postoperative time to extubation,postoperative complications,postoperative time of hospital stay,total hospitalization cost,and levels of white blood cell(WBC)count,C-reactive protein(CRP),alanine aminotransferase(ALT),and gamma-glutamyl transferase(GGT)on the first day after surgery were compared between the two groups.Results Compared with the control group,the ICG group demonstrated a shorter time to identify three ducts[(30.4±13.9)min vs(38.4±12.9)min],lower intraoperative blood loss[(17.4±10.0)mL vs(21.6±11.7)mL],shorter operation time[(56.9±19.6)min vs(64.0±16.9)min]and shorter time of postoperative hospital stay[2(2,3)d vs 3(3,4)d],the differences were all significant(P<0.05).No significant difference was observed between the two groups in terms of intraoperative drainage tube placement,intraoperative bile duct injury,levels of WBC count,CRP,ALT,and GGT on the first day after surgery,postoperative time to extubation,postoperative complications or total hospitalization cost(P>0.05).Conclusion The application of ultra-low fixed dose ICG fluorescence navigation technology in laparoscopic difficult cholecystectomy is safe and feasible.It improves the identification rate of gallbladder duct,common hepatic duct and common bile duct,reduces intraoperative bleeding,shorten operation time and postoperative time of hospital stay.
王天斌;应建义;张宁宁;卢毅;张成武
仙居县人民医院/浙江省人民医院浙东南院区/杭州医学院附属仙居医院普外科,浙江 台州 317300仙居县人民医院/浙江省人民医院浙东南院区/杭州医学院附属仙居医院普外科,浙江 台州 317300仙居县人民医院/浙江省人民医院浙东南院区/杭州医学院附属仙居医院普外科,浙江 台州 317300浙江省人民医院肝胆胰外科/微创外科,浙江 杭州 310014浙江省人民医院肝胆胰外科/微创外科,浙江 杭州 310014
医药卫生
腹腔镜胆囊切除术吲哚菁绿荧光导航超低固定剂量胆囊管肝总管胆总管术中胆管损伤
laparoscopic cholecystectomyindocyanine greenfluorescence navigationultra-low fixed dosegallbladder ductcommon hepatic ductcommon bile ductintraoperative bile duct injury
《肝胆胰外科杂志》 2026 (3)
181-186,6
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