Shibata Hideki, Aoki Takeshi, Koizumi Tomotake, Kusano Tomokazu, Yamazaki Tatsuya, Saito Kazuhiko, Hirai Takahito, Tomioka Kodai, Wada Yusuke, Hakozaki Tomoki, Tashiro Yoshihiko, Nogaki Koji, Yamada Kosuke, Matsuda Kazuhiro, Fujimori Akira, Enami Yuta, Murakami Masahiko
Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan.
Clin Exp Gastroenterol. 2021 Apr 30;14:145-154. doi: 10.2147/CEG.S275985. eCollection 2021.
Bile duct injury is one of the most serious complications of laparoscopic cholecystectomy. Intraoperative indocyanine green (ICG) cholangiography is a safe and useful navigation modality for confirming the biliary anatomy. ICG cholangiography is expected to be a routine method for helping avoid bile duct injuries.
We examined 25 patients who underwent intraoperative cholangiography using ICG fluorescence. Two methods of ICG injection are used: intrabiliary injection (percutaneous transhepatic gallbladder drainage [PTGBD], gallbladder [GB] puncture and endoscopic nasobiliary drainage [ENBD]) at a dosage of 0.025 mg during the operation or intravenous injection with 2.5 mg ICG preoperatively.
There were 24 patients who underwent laparoscopic cholecystectomy and 1 patient who underwent hepatectomy. For laparoscopic cholecystectomy, the average operation time was 127 (50-197) minutes, and estimated blood loss was 43.2 (0-400) g. The ICG administration route was intravenous injections in 12 cases and intrabiliary injection in 12 cases (GB injection: 3 cases, PTGBD: 8 cases, ENBD:1 case). The course of the biliary tree was able to be confirmed in all cases that received direct injection into the biliary tract, whereas bile structures were recognizable in only 10 cases (83.3%) with intravenous injection. The postoperative hospital stay was 4.6 (3-9) days, and no postoperative complications (Clavien-Dindo ≧IIIa) were observed. For hepatectomy, a tumor located near the left Glissonian pedicle was resected using a fluorescence image guide. Biliary structures were fluorescent without injury after resecting the tumor. No adverse events due to ICG administration were observed, and the procedure was able to be performed safely.
ICG fluorescence imaging allows surgeons to visualize the course of the biliary tree in real time during cholecystectomy and hepatectomy. This is considered essential for hepatobiliary surgery to prevent biliary tree injury and ensure safe surgery.
胆管损伤是腹腔镜胆囊切除术最严重的并发症之一。术中吲哚菁绿（ICG）胆管造影是一种用于确认胆道解剖结构的安全且有用的导航方式。ICG胆管造影有望成为有助于避免胆管损伤的常规方法。
我们检查了25例行ICG荧光术中胆管造影的患者。使用了两种ICG注射方法：术中经皮经肝胆道引流（PTGBD）、胆囊（GB）穿刺和内镜鼻胆管引流（ENBD）进行胆管内注射，剂量为0.025mg，或术前静脉注射2.5mg ICG。
24例行腹腔镜胆囊切除术，1例行肝切除术。对于腹腔镜胆囊切除术，平均手术时间为127（50 - 197）分钟，估计失血量为43.2（0 - 400）g。ICG给药途径为静脉注射12例，胆管内注射12例（GB注射：3例，PTGBD：8例, ENBD：1例）。在所有直接注入胆道的病例中均能确认胆管树的走行，而静脉注射时仅10例（83.3%）可识别胆管结构。术后住院时间为4.6（3 - 9）天，未观察到术后并发症（Clavien - Dindo≧IIIa）。对于肝切除术，使用荧光图像引导切除了位于左肝蒂附近的肿瘤。切除肿瘤后胆管结构荧光显影且未受损伤。未观察到因ICG给药引起的不良事件，该手术得以安全进行。
ICG荧光成像使外科医生在胆囊切除术和肝切除术中能够实时可视化胆管树的走行。这被认为对于肝胆手术预防胆管树损伤和确保手术安全至关重要。
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