Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, District of Columbia, USA.
Department of Surgery, MedStar Georgetown University Hospital and Washington Hospital Center, Washington, District of Columbia, USA.
Lasers Surg Med. 2023 Jul;55(5):480-489. doi: 10.1002/lsm.23661. Epub 2023 Apr 1.
Postoperative bile leakage is a common complication of hepatobiliary surgery and frequently requires procedural intervention. Bile-label 760 (BL-760), a novel near-infrared dye, has emerged as a promising tool for identifying biliary structures and leakage, owing to its rapid excretion and strong bile specificity. This study aimed to assess the intraoperative detection of biliary leakage using intravenously administered BL-760 compared with intravenous (IV) and intraductal (ID) indocyanine green (ICG).
Laparotomy and segmental hepatectomy with vascular control were performed on two 25-30 kg pigs. ID ICG, IV ICG, and IV BL-760 were administered separately, followed by an examination of the liver parenchyma, cut liver edge, and extrahepatic bile ducts for areas of leakage. The duration of intra- and extrahepatic fluorescence detection was assessed, and the target-to-background (TBR) of the bile ducts to the liver parenchyma was quantitatively measured.
In Animal 1, after intraoperative BL-760 injection, three areas of leaking bile were identified within 5 min on the cut liver edge with a TBR of 2.5-3.8 that was not apparent to the naked eye. In contrast, after IV ICG administration, the background parenchymal signal and bleeding obscured the areas of bile leakage. A second dose of BL-760 demonstrated the utility of repeated injections, confirming two of the three previously visualized areas of bile leakage and revealing one previously unseen leak. In Animal 2, neither ID ICG nor IV BL-760 injections showed obvious areas of bile leakage. However, fluorescence signals were observed within the superficial intrahepatic bile ducts after both injections.
BL-760 enables the rapid intraoperative visualization of small biliary structures and leaks, with the benefits of fast excretion, repeatable intravenous administration, and high-fluorescence TBR in the liver parenchyma. Potential applications include the identification of bile flow in the portal plate, biliary leak or duct injury, and postoperative monitoring of drain output. A thorough assessment of the intraoperative biliary anatomy could limit the need for postoperative drain placement, a possible contributor to severe complications and postoperative bile leak.
术后胆漏是肝胆外科的常见并发症，常需要进行介入治疗。新型近红外染料胆液标记物 760（BL-760）由于其快速排泄和强胆汁特异性，已成为识别胆管结构和渗漏的有前途的工具。本研究旨在评估与静脉内（IV）和胆管内（ID）吲哚菁绿（ICG）相比，静脉内给予 BL-760 对内漏的术中检测。
对两只 25-30kg 的猪进行剖腹手术和节段性肝切除术，并进行血管控制。分别给予 ID ICG、IV ICG 和 IV BL-760，然后检查肝实质、切缘和肝外胆管有无渗漏区。评估肝内和肝外荧光检测的持续时间，并定量测量胆管与肝实质的靶标与背景（TBR）比值。
在动物 1 中，BL-760 术中注射后，在 5 分钟内在切缘上发现了 3 个漏胆区域，TBR 为 2.5-3.8，肉眼观察不到。相比之下，给予 IV ICG 后，背景实质信号和出血掩盖了胆漏区域。重复注射 BL-760 证明了重复注射的效用，证实了之前观察到的 3 个漏胆区域中的 2 个，并发现了一个之前未发现的漏胆。在动物 2 中，ID ICG 和 IV BL-760 注射均未显示明显的胆漏区域。然而，两种注射后均观察到肝内浅胆管内有荧光信号。
BL-760 可快速术中可视化小胆管结构和渗漏，具有快速排泄、可重复静脉内给药和肝实质高荧光 TBR 的优点。潜在应用包括识别门脉板内胆汁流动、胆漏或胆管损伤，以及术后引流液监测。对内胆术中解剖的全面评估可能会限制术后引流放置的需要，这可能是严重并发症和术后胆漏的一个潜在因素。
