Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Surgery. 2010 Jul;148(1):87-95. doi: 10.1016/j.surg.2009.12.004. Epub 2010 Feb 1.
Iatrogenic bile duct injuries are serious complications with patient morbidity. We hypothesized that the invisible near-infrared (NIR) fluorescence properties of methylene blue (MB) and indocyanine green (ICG) could be exploited for real-time, intraoperative imaging of the extrahepatic bile ducts during open and laparoscopic surgeries.
In all, 2.0 mg/kg of MB and 0.05 mg/kg of ICG were injected intravenously into 35-kg female Yorkshire pigs and the extrahepatic bile ducts were imaged over time using either the Fluorescence-Assisted Resection and Exploration (FLARE) image-guided surgery system (open surgery) or a custom NIR fluorescence laparoscopy system. Surgical anatomy was confirmed using x-ray cholangiography. The contrast-to-background ratio (CBR), contrast-to-liver ratio (CLR), and chemical concentrations in the cystic duct (CD) and common bile duct (CBD) were measured, and the performance of each agent was quantified.
Using NIR fluorescence of MB, the CD and CBD could be identified with good sensitivity (CBR and CLR > or =4), during both open and laparoscopic surgeries, from 10 to 120 min postinjection. Functional impairment of the ducts, including constriction and injury were immediately identifiable. Using NIR fluorescence of ICG, extrahepatic bile ducts did not become visible until 90 min postinjection because of strong residual liver retention; however, between 90 and 240 min, ICG provided exquisitely high sensitivity for both CD and CBD, with CBR > or =8 and CLR > or =4.
We demonstrate that 2 clinically available NIR fluorophores, MB fluorescing at 700 nm and ICG fluorescing at 800 nm, provide sensitive, prolonged identification of the extrahepatic bile ducts and assessment of their functional status.
医源性胆管损伤是一种严重的并发症，会导致患者发病。我们假设亚甲蓝（MB）和吲哚菁绿（ICG）的不可见近红外（NIR）荧光特性可用于在开腹和腹腔镜手术中实时、术中成像肝外胆管。
将 2.0mg/kg 的 MB 和 0.05mg/kg 的 ICG 静脉注射到 35kg 的雌性约克夏猪体内，然后使用 Fluorescence-Assisted Resection and Exploration (FLARE) 图像引导手术系统（开腹手术）或定制的 NIR 荧光腹腔镜系统对肝外胆管进行随时间成像。使用 X 射线胆管造影术确认手术解剖结构。测量胆囊管（CD）和胆总管（CBD）中的对比背景比（CBR）、对比肝脏比（CLR）和化学浓度，并定量分析每种试剂的性能。
使用 MB 的 NIR 荧光，在注射后 10 至 120 分钟内，CD 和 CBD 可以在开腹和腹腔镜手术中以高灵敏度（CBR 和 CLR≥4）识别。可以立即识别胆管的功能障碍，包括收缩和损伤。使用 ICG 的 NIR 荧光，由于残留肝脏的强烈滞留，肝外胆管直到注射后 90 分钟才可见；然而，在 90 至 240 分钟之间，ICG 对 CD 和 CBD 均提供了极高的灵敏度，CBR≥8，CLR≥4。
我们证明，两种临床可用的 NIR 荧光团，MB 在 700nm 处发荧光，ICG 在 800nm 处发荧光，可提供肝外胆管的敏感、持久识别，并评估其功能状态。
