Department of Surgical Gastroenterology and Minimally Invasive Surgery, Sahasra Hospitals, Jayanagar, Bangalore, India.
Medicine (Baltimore). 2022 Oct 21;101(42):e31170. doi: 10.1097/MD.0000000000031170.
ICG fluorescence (ICGF) guidance during laparoscopic cholecystectomy (LC) is gaining wider acceptance. While the accruing data largely addresses ICGF guidance during LC in patients with uncomplicated gallstone disease (UGS) and acute cholecystitis, there is a paucity of data related for complicated gall stone disease (CGS) such as choledocholithiasis, bilio-enteric fistula, remnant gall bladder, etc. The purpose of this study was to evaluate the role of ICGF during LC in the spectrum of CGS with state of the art 4 chip camera system. Retrospective review from a prospectively maintained database of all patients who underwent ICGF guided LC during the period June 1st, 2019 till December 30th, 2021 formed part of the study. Clinical profile and findings on ICGF during LC for CGS were studied. The data was studied to evaluate the potential roles of ICGF during LC for CGS. Of 68 patients, there were 29 males and 39 females. Among them were 32 and 36 in the uncomplicated and complicated gallstone disease groups, respectively. ICGF showed CBD visualization in 67(98.5%) and cystic duct in 62(91%). ICGF guidance helped in management of CGS, prior to, during and after completion of LC. It had novel application in patients undergoing CBD exploration. In our small series of patients with CGS, ICGF guidance enabled a LC and laparoscopic subtotal cholecystectomy in 94% and 6% of patients respectively. The study highlights potential roles and advantages with ICGF guided laparoscopic management for CBD stones, bilioenteric fistula, completion cholecystectomy and cystic duct stones. Large scale multicenter prospective studies are required to clarify the role of ICGF in the wide spectrum of CGS.
在腹腔镜胆囊切除术 (LC) 中，吲哚菁绿荧光 (ICGF) 引导越来越被广泛接受。虽然越来越多的数据主要解决了在没有并发症的胆囊疾病 (UGS) 和急性胆囊炎患者中进行 LC 时的 ICGF 引导问题，但对于复杂的胆囊疾病 (CGS)，如胆总管结石、胆肠瘘、残余胆囊等，相关数据却很少。本研究旨在评估在 CGS 范围内使用最先进的 4 芯片相机系统进行 ICGF 引导 LC 的作用。回顾性分析了 2019 年 6 月 1 日至 2021 年 12 月 30 日期间接受 ICGF 引导 LC 的所有患者的前瞻性维护数据库。研究了 CGS 患者在 LC 期间进行 ICGF 的临床特征和发现。对数据进行了研究，以评估在 CGS 中进行 LC 时 ICGF 的潜在作用。在 68 例患者中，有 29 例男性和 39 例女性。其中，无并发症和复杂胆囊疾病组分别为 32 例和 36 例。ICGF 在 67 例患者（98.5%）中显示 CBD 可视化，在 62 例患者（91%）中显示胆囊管可视化。ICGF 指导有助于在 LC 之前、期间和之后管理 CGS。它在进行 CBD 探查的患者中有新的应用。在我们的小系列 CGS 患者中，ICGF 引导使 94%的患者能够进行 LC 和腹腔镜胆囊次全切除术，而 6%的患者需要进行腹腔镜胆囊次全切除术。该研究强调了 ICGF 引导腹腔镜管理在治疗 CBD 结石、胆肠瘘、完成胆囊切除术和胆囊管结石方面的潜在作用和优势。需要进行大规模多中心前瞻性研究，以阐明 ICGF 在广泛的 CGS 中的作用。
