术中近红外荧光胆管造影术（NIRFC）在胆管损伤小鼠模型中的应用。
Intraoperative near-infrared fluorescent cholangiography (NIRFC) in mouse models of bile duct injury.
机构信息
Center for Molecular Imaging Research, Massachusetts General Hospital and Harvard Medical School, Building 149, 13th Street, Charlestown, MA 02129, USA.
出版信息
World J Surg. 2010 Feb;34(2):336-43. doi: 10.1007/s00268-009-0332-8.
BACKGROUND
Accidental injury to the common bile duct is a rare but serious complication of laparoscopic cholecystectomy. Accurate visualization of the biliary ducts may prevent injury or allow its early detection. Conventional X-ray cholangiography is often used and can mitigate the severity of injury when correctly interpreted. However, it may be useful to have an imaging method that could provide real-time extrahepatic bile duct visualization without changing the field of view from the laparoscope. The purpose of the present study was to test a new near-infrared (NIR) fluorescent agent that is rapidly excreted via the biliary route in preclinical models to evaluate intraoperative real-time near infrared fluorescent cholangiography (NIRFC).
METHODS
To investigate probe function and excretion, a lipophilic near-infrared fluorescent agent with hepatobiliary excretion was injected intravenously into one group of C57/BL6 control mice and four groups of C57/BL6 mice under the following experimentally induced conditions: (1) chronic biliary obstruction, (2) acute biliary obstruction (3) bile duct perforation, and (4) choledocholithiasis, respectively. The biliary system was imaged intravitally for 1 h with near-infrared fluorescence (NIRF) with an intraoperative small animal imaging system (excitation 649 nm, emission 675 nm).
RESULTS
The extrahepatic ducts and extraluminal bile were clearly visible due to the robust fluorescence of the excreted fluorochrome. Twenty-five minutes after intravenous injection, the target-to-background ratio peaked at 6.40 +/- 0.83 but signal was clearly visible for ~60 min. The agent facilitated rapid identification of biliary obstruction and bile duct perforation. Implanted beads simulating choledocholithiasis were promptly identifiable within the common bile duct lumen.
CONCLUSIONS
Near-infrared fluorescent agents with hepatobiliary excretion may be used intraoperatively to visualize extrahepatic biliary anatomy and physiology. Used in conjunction with laparoscopic imaging technologies, the use of this technique should enhance hepatobiliary surgery.
背景
胆总管损伤是腹腔镜胆囊切除术罕见但严重的并发症。准确显示胆管可以防止损伤或允许早期发现。常规 X 射线胆管造影术常被使用，并且在正确解释时可以减轻损伤的严重程度。然而，拥有一种可以提供实时肝外胆管可视化的成像方法可能会很有用，而无需改变腹腔镜的视野。本研究的目的是测试一种新的近红外（NIR）荧光剂，该荧光剂在临床前模型中通过胆管迅速排泄，以评估术中实时近红外荧光胆管造影术（NIRFC）。
方法
为了研究探针的功能和排泄，一组 C57/BL6 对照小鼠和四组 C57/BL6 小鼠分别在以下实验诱导条件下静脉注射亲脂性近红外荧光剂进行肝胆排泄：（1）慢性胆管阻塞，（2）急性胆管阻塞，（3）胆管穿孔和（4）胆总管结石。使用术中小动物成像系统（激发 649nm，发射 675nm）对胆道进行活体近红外荧光（NIRF）成像 1 小时。
结果
由于排泄的荧光染料具有很强的荧光，因此可以清晰地看到肝外胆管和管外胆汁。静脉注射后 25 分钟，靶标与背景的比值达到 6.40 +/- 0.83 的峰值，但信号仍清晰可见约 60 分钟。该试剂有助于快速识别胆道阻塞和胆管穿孔。模拟胆总管结石的植入珠可迅速在胆总管腔内识别。
结论
具有肝胆排泄的近红外荧光剂可用于术中可视化肝外胆道解剖和生理学。与腹腔镜成像技术结合使用，该技术的使用应增强肝胆手术。
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