Upper GI Unit, St Thomas Hospital, 8945Guys and St Thomas NHS Foundation Trust, UK.
Emergency General Surgery, St Thomas Hospital, 8945Guys and St Thomas NHS Foundation Trust, UK.
Surg Innov. 2022 Aug;29(4):526-531. doi: 10.1177/1553350620958562. Epub 2020 Sep 16.
Emergency cholecystectomy is the gold standard treatment for acute cholecystitis according to National Institute for Health and Care Excellence recommendations. The procedure is feasible but carries a higher risk of iatrogenic injury to the bile duct, which should be considered preventable. Intraoperative fluorescence cholangiography following injection of indocyanine green (ICG) has been reported to aid identification of the extrahepatic bile duct. Data on its feasibility in the context of emergency cholecystectomies are missing. Fluorescent ICG was used intraoperatively to enhance the biliary anatomy during 33 consecutive emergency laparoscopic cholecystectomies at our institution. Primary outcomes of surgery were considered the length of hospital stay, conversion to open and complications rate, including bile duct injury. Secondary outcome was operating time. A historical population of emergency cholecystectomies was used as control. There were no common bile duct injuries, no adverse effects from ICG, no conversion to open surgery and no deaths. 90% of patients went home within 48 hours after the operation in the absence of complications. ICG demonstrated intraoperative biliary anatomy allowing greater confidence to the surgeon performing emergency cholecystectomies. Six patients were operated beyond 72 hours from admission, without experiencing any complication Clavien-Dindo ≥3. ICG population had the same post-operative hospitalisation and complications rate of the control group, with a shorter operating time. Intraoperative augmented visualisation of biliary anatomy with ICG cholangiography can be a useful technology tool, with the potential to extend the 72 hours window of safety for emergency cholecystectomies.
根据国家卫生与保健卓越研究所的建议，急性胆囊炎的黄金标准治疗方法是急诊胆囊切除术。该手术可行，但存在更高的医源性胆管损伤风险，应认为是可预防的。据报道，在注射吲哚菁绿（ICG）后进行术中荧光胆管造影术有助于识别肝外胆管。关于其在急诊胆囊切除术中可行性的数据尚缺。荧光 ICG 术中用于增强我院连续 33 例急诊腹腔镜胆囊切除术中的胆道解剖结构。手术的主要结局是住院时间、中转开腹率和并发症发生率，包括胆管损伤。次要结果是手术时间。使用急诊胆囊切除术的历史人群作为对照。没有胆总管损伤，ICG 无不良反应，无中转开腹，无死亡。90%的患者在无并发症的情况下术后 48 小时内出院。ICG 术中显示了胆道解剖结构，使进行急诊胆囊切除术的外科医生更有信心。6 名患者在入院后 72 小时以上接受了手术，没有任何并发症 Clavien-Dindo≥3。ICG 组的术后住院时间和并发症发生率与对照组相同，手术时间更短。术中使用 ICG 胆管造影增强胆道解剖可视化可以成为一种有用的技术工具，有可能将急诊胆囊切除术的 72 小时安全窗口延长。
