Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan.
J Hepatobiliary Pancreat Sci. 2010 Sep;17(5):595-600. doi: 10.1007/s00534-009-0195-2. Epub 2009 Oct 6.
BACKGROUND/PURPOSE: We evaluated the usefulness of intraoperative exploration of the biliary anatomy using fluorescence imaging with indocyanine green (ICG) in experimental and clinical cholecystectomies.
The experimental study was done using two 40-kg pigs and the clinical study was done in 12 patients for whom cholecystectomy was planned from January 2009 to June 2009. Initially we used a laparoscopic approach for the evaluation of fluorescence imaging of the biliary system in the two pigs. Then the clinical study was started on the basis of these experimental results. ICG (1.0 ml/body of 2.5 mg/ml ICG) was infused 1-2 h before surgery. With the subjects under general anesthesia we observed in real time the condition of the biliary tract under the guidance of fluorescence imaging employing an infrared camera or a prototype laparoscope. ICG was added intravenously to observe the location or flow condition of the cystic artery.
We obtained a clear view of the biliary tract and the location of the cystic duct in the two pigs. Local compression with a transparent hemispherical plastic device was effective for offering a clearer view. The biliary tract, except for the gallbladder, was clearly recognized in all clinical subjects. Local compression with a transparent hemispherical plastic device for open cholecystectomy and a flat plastic device for laparoscopy provided clearer visualization of the confluence between the cystic duct and common bile duct or common hepatic duct. The location of the cystic artery was revealed after division of the connective tissues, and the flow condition of the cystic artery was confirmed 7-10 s after intravenous re-infusion of ICG. There were no adverse events related to the intraoperative procedure or the ICG itself.
This method is safe and easy for the identification of the biliary anatomy, without requiring cannulation into the cystic duct, X-ray equipment, or the use of radioactive materials. Although fluorescence imaging is still at an early stage of application in comparison with ordinary intraoperative cholangiography, we expect that this method will become routine, offering a lower degree of invasiveness that will help avoid bile duct injury.
背景/目的：我们评估了使用吲哚菁绿（ICG）荧光成像术中探查胆道解剖结构在实验和临床胆囊切除术的实用性。
该实验研究在两只 40 公斤的猪中进行，临床研究在 2009 年 1 月至 6 月期间计划进行胆囊切除术的 12 名患者中进行。最初，我们使用腹腔镜方法评估了两只猪的胆道荧光成像。然后，根据这些实验结果开始进行临床研究。在手术前 1-2 小时，将 1.0ml/2.5mg/mlICG 剂量的 ICG 注入患者体内。在全麻下，我们实时观察在荧光成像引导下胆道的情况，采用红外摄像机或原型腹腔镜。我们静脉内注射 ICG 以观察胆囊动脉的位置或血流情况。
我们在两只猪中获得了胆道和胆囊管位置的清晰图像。使用透明半球形塑料装置进行局部压迫对于提供更清晰的视野是有效的。除了胆囊外，所有临床患者的胆道均能清晰识别。对于开放性胆囊切除术，使用透明半球形塑料装置，对于腹腔镜手术，使用扁平塑料装置进行局部压迫，可更清晰地显示胆囊管与胆总管或肝总管汇合处。在分离结缔组织后显示胆囊动脉的位置，并在静脉内重新注入 ICG 后 7-10 秒确认胆囊动脉的血流情况。术中操作或 ICG 本身没有与不良事件相关。
与普通术中胆管造影术相比，该方法安全且易于识别胆道解剖结构，无需胆管插管、X 射线设备或放射性物质。虽然荧光成像术的应用仍处于早期阶段，但我们期望这种方法将成为常规方法，具有较低的侵入性，有助于避免胆管损伤。
