Utsunomiya Takeshi, Sakamoto Katsunori, Sogabe Kyousei, Takenaka Ryoichi, Hayashi Tatsuya, Ogura Fumiya, Yamamoto Hisato, Ishida Naoki, Nakamura Taro, Sakamoto Akimasa, Iwata Miku, Ito Chihiro, Matsui Takashi, Nishi Yusuke, Shine Mikiya, Uraoka Mio, Nagaoka Tomoyuki, Tamura Kei, Funamizu Naotake, Ogawa Kohei, Takada Yasutsugu
Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan.
Department of Surgery, Uwajima City Hospital, 1-1 Gotenmachi, Ehime, 798-8510, Japan.
Surg Case Rep. 2021 Nov 29;7(1):250. doi: 10.1186/s40792-021-01333-1.
Two cases of laparoscopic remnant cholecystectomy using near-infrared fluorescence cholangiography (NIFC) for remnant gallbladder calculi following subtotal-cholecystectomy are reported. Case 1: a 36-year-old woman was referred to our hospital with acute abdomen. Computed tomography showed remnant gallbladder calculi, with detected no other findings as the cause of the abdominal pain. For intraoperative exploration of the biliary anatomy, 0.25 mg/kg of indocyanine green (ICG) was administered intravenously the day before the operation. NIFC clearly showed the common bile duct and enabled safe laparoscopic remnant cholecystectomy. She was free from symptoms after the operation. Case 2: a 40-year-old woman was referred to our hospital with epigastralgia due to remnant gallbladder calculi after open cholecystectomy. ICG was administered intravenously the day before the operation. Severe adhesions were observed in the upper abdominal cavity and there was tight adherence of the duodenum to the remnant gallbladder. NIFC showed a clear margin that appeared to be the margin between the duodenum and remnant gallbladder. However, dissection of the margin observed by NIFC caused perforation of the duodenum. The clear margin seen with NIFC was likely due to visualization of the gallbladder through the duodenum. Although NIFC is a useful modality for confirming the intraoperative biliary anatomy, it is important not to rely too heavily on NIFC alone, which may lead to misinterpretation of the anatomy.
本文报告了两例采用近红外荧光胆管造影术（NIFC）进行腹腔镜残余胆囊切除术治疗次全胆囊切除术后残余胆囊结石的病例。病例1：一名36岁女性因急腹症转诊至我院。计算机断层扫描显示有残余胆囊结石，未发现其他导致腹痛的病因。为了术中探查胆道解剖结构，术前一天静脉注射0.25mg/kg吲哚菁绿（ICG）。NIFC清晰显示了胆总管，使得腹腔镜残余胆囊切除术得以安全进行。术后她症状消失。病例2：一名40岁女性因开腹胆囊切除术后残余胆囊结石导致上腹部疼痛转诊至我院。术前一天静脉注射ICG。上腹部腹腔观察到严重粘连，十二指肠与残余胆囊紧密粘连。NIFC显示出一个清晰的边界，似乎是十二指肠与残余胆囊之间的边界。然而，对NIFC观察到的边界进行分离导致十二指肠穿孔。NIFC看到的清晰边界可能是由于通过十二指肠对胆囊的显影。虽然NIFC是确认术中胆道解剖结构的一种有用方法，但重要的是不要过于依赖NIFC，否则可能导致对解剖结构的错误解读。
