van Dam Dieuwertje A, Ankersmit Marjolein, van de Ven Peter, van Rijswijk Anne-Sophie, Tuynman Jurriaan B, Meijerink Wilhelmus J H J
1 Department of Surgery, VU University Medical Centre , Amsterdam, The Netherlands .
2 Department of Epidemiology, VU University Medical Centre , Amsterdam, The Netherlands .
J Laparoendosc Adv Surg Tech A. 2015 Jun;25(6):486-92. doi: 10.1089/lap.2014.0248. Epub 2015 May 14.
The aim of this study was to test and validate a novel noninvasive method for intraoperative visualization of extrahepatic bile ducts during laparoscopic cholecystectomy. Injury to the common bile duct (CBD) is a rare but major complication of laparoscopic cholecystectomy. Most injuries occur when anatomy is unclear due to the presence of anatomic variations, acute inflammation, or adhesions.
Thirty patients were included, and each received an intravenous injection of 0.05 mg/kg of indocyanine green (ICG) (ICG-Pulsion(®); PULSION Medical Systems AG, Munich, Germany) prior to the start of surgery. Laparoscopic cholecystectomy was performed according to standard procedures. The CBD and cystic duct (CD) were visualized before and during dissection of the liver hilus using a conventional laparoscopic camera and a recently developed near-infrared (NIR) camera (Olympus, Tokyo, Japan).
Using ICG-NIR, the CBD and CD could be visualized 11 minutes (P=.008) and 8.6 minutes (P=.001) earlier than with a conventional camera. Both early (20/30 patients) and late (26/30 patients) identification of the CBD with ICG-NIR was significantly more frequent compared with conventional images (2/30 and 10/30, respectively; P<.001). One postoperative bilioma required re-admission and endoscopic retrograde cholangiopancreatography with stent placement.
Identification of the CBD and CD using a low dose of ICG and the NIR camera was both faster and more frequent compared with conventional laparoscopic images during elective laparoscopic cholecystectomy.
本研究的目的是测试并验证一种新型无创方法，用于在腹腔镜胆囊切除术期间术中可视化肝外胆管。胆总管（CBD）损伤是腹腔镜胆囊切除术罕见但严重的并发症。大多数损伤发生在由于解剖变异、急性炎症或粘连导致解剖结构不清楚时。
纳入30例患者，每位患者在手术开始前静脉注射0.05mg/kg吲哚菁绿（ICG）（ICG-Pulsion(®)；德国慕尼黑普升医疗系统公司）。按照标准程序进行腹腔镜胆囊切除术。在肝门解剖之前和期间，使用传统腹腔镜摄像头和最近开发的近红外（NIR）摄像头（日本东京奥林巴斯）对CBD和胆囊管（CD）进行可视化。
使用ICG-NIR，CBD和CD的可视化时间分别比传统摄像头早11分钟（P = 0.008）和8.6分钟（P = 0.001）。与传统图像相比（分别为2/30和10/30），使用ICG-NIR早期（20/30例患者）和晚期（26/30例患者）识别CBD的频率显著更高（P < 0.001）。1例术后胆汁瘤患者需要再次入院并进行内镜逆行胰胆管造影及支架置入。
在择期腹腔镜胆囊切除术中，与传统腹腔镜图像相比，使用低剂量ICG和NIR摄像头识别CBD和CD更快且更频繁。
