Department of Clinical Medicine, Medical College of Soochow University, Suzhou, 215006, Jiangsu, People's Republic of China.
Department of General Surgery, Cancer Center, Division of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China.
Langenbecks Arch Surg. 2022 Nov;407(7):2823-2832. doi: 10.1007/s00423-022-02570-0. Epub 2022 Jul 19.
Laparoscopic duodenum-preserving pancreatic head resection (L-DPPHR) is technically demanding with extreme difficulty in biliary preservation. Only a few reports of L-DPPHR are available with alarming bile leakage, and none of them revealed the long-term metabolic outcomes. For the first time, our study explored the different dosage and timing of indocyanine green (ICG) for guiding L-DPPHR and described the long-term metabolic results.
Between October 2015 and January 2021, different dosage and timing of ICG were administrated preoperatively and evaluated intra-operatively using Image J software to calculate the relative fluorescence intensity ratio of signal-to-noise contrast between bile duct and pancreas. Short-term complications and long-term metabolic disorder were collected in a prospectively maintained database and analyzed retrospectively.
Twenty-five patients were enrolled without conversion to laparotomy or pancreaticoduodenectomy. Administrating a dosage of 0.5 mg/kg 24 h before the operation had the highest relative fluorescence intensity ratio of 19.3, and it proved to guide the biliary tract the best. Fifty-six percent of patients suffered from postoperative complications with 48% experiencing pancreatic fistula and 4% having bile leakage. No one suffered from the duodenal necrosis, and there was no mortality. When compared with the non-ICG group, the ICG group had a comparable diameter of tumor and similar safety distance from lesions to common bile duct; however, it decreased the incidence of bile leakage from 10% to none. The median length of hospital stay was 16 days. After a median follow-up of 26.6 months, no one had tumor recurrence or refractory cholangitis. No postoperative new onset of diabetes mellitus (pNODM) was observed, while pancreatic exocrine insufficiency (pPEI) and non-alcoholic fatty liver disease (NAFLD) were seen in 4% of patients 12 months after the L-DPPHR.
L-DPPHR is feasible and safe in selected patients, and real-time ICG imaging with proper dosage and timing may greatly facilitate the identification and the prevention of biliary injury. And it seemed to be oncological equivalent to PD with preservation of metabolic function without refractory cholangitis.
腹腔镜保留十二指肠胰头切除术（L-DPPHR）技术要求高，胆管保留难度极大。仅有少数关于 L-DPPHR 的报告存在令人担忧的胆漏，而且没有一份报告揭示其长期代谢结果。我们首次探讨了不同剂量和时间的吲哚菁绿（ICG）用于指导 L-DPPHR 的效果，并描述了长期代谢结果。
2015 年 10 月至 2021 年 1 月，我们在术前给予不同剂量和时间的 ICG，并使用 Image J 软件在术中评估，计算胆管和胰腺之间信号与噪声对比度的相对荧光强度比值。我们在一个前瞻性维护的数据库中收集短期并发症和长期代谢紊乱，并进行回顾性分析。
25 例患者未转为开腹或胰十二指肠切除术。术前 24 小时给予 0.5mg/kg 的剂量时，相对荧光强度比值最高，为 19.3，证明其可以最好地指导胆管。56%的患者发生术后并发症，其中 48%发生胰瘘，4%发生胆漏。没有人发生十二指肠坏死，也没有死亡。与非 ICG 组相比，ICG 组肿瘤直径相似，病变与胆总管的安全距离相似，但胆漏发生率从 10%降至 0。中位住院时间为 16 天。中位随访 26.6 个月后，无肿瘤复发或难治性胆管炎。术后新发糖尿病（pNODM）无发生，术后 12 个月有 4%的患者出现胰腺外分泌功能不全（pPEI）和非酒精性脂肪性肝病（NAFLD）。
在选择的患者中，L-DPPHR 是可行且安全的，使用适当的剂量和时间进行实时 ICG 成像可以极大地帮助识别和预防胆管损伤。而且，与 PD 相比，它似乎具有相同的肿瘤学效果，保留了代谢功能，没有难治性胆管炎。
