Liver Transplantation Center, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan Province, China.
Department of Hepato-Pancreato-Biliary Surgery, The People's Hospital of Leshan, Leshan, 614000, China.
Sci Rep. 2024 Jan 29;14(1):2380. doi: 10.1038/s41598-024-52904-9.
This paper explores the feasibility and principle of hepatic parenteral fluorescence imaging technology after retrograde injection of indocyanine green (ICG) through endoscopic nasobiliary drainage (ENBD). The data were collected from 53 patients with cholecystolithiasis and choledocholithiasis, from October 2022 to March 2023, diagnosed by fluorescence imaging technique retrograde biliary approach (FIT-RB). We divided the patients into two groups according to the features of liver parenchyma, the poor group (n = 34, including scattered or no imaging) and the good group (n = 19, regular uniform imaging). We compared and analyzed the perioperative results of the two groups and explored the influencing factors of the success of FIT-RB and the ICG concentration suitable for this imaging technique. The good imaging rate of the 53 enrolled cases was 35.8%. The bilirubin level before ENBD and laparoscopic cholecystectomy in the poor group was significantly higher than that in the good group (P < 0.001). The proportion of higher ICG concentrations (0.5 mg/mL) was significantly higher in the good group (P = 0.028). Our results demonstrated that the success rate of good imaging was 4.53 times higher than that of low-dose ICG (0.125 or 0.25 mg/L) cases at 0.5 mg/ml of ICG. The level of total bilirubin and direct bilirubin were negatively correlated with the imaging effect, and total bilirubin and direct bilirubin levels were important predictors of the efficacy of FIT-RB. FIT-RB is safe and feasible in patients with low site bilirubin levels. An ICG concentration of 0.5 mg/ml may be ideal for implementing this technique.
本文探讨了经内镜鼻胆管引流(ENBD)逆行注射吲哚菁绿(ICG)后进行肝外荧光成像技术的可行性和原理。该研究的数据来自于 2022 年 10 月至 2023 年 3 月期间,53 例经荧光成像技术逆行胆道途径(FIT-RB)诊断为胆石症和胆总管结石的患者。我们根据肝实质特征将患者分为两组,差组(n=34,包括散在或无成像)和优组(n=19,规则均匀成像)。我们比较和分析了两组的围手术期结果,并探讨了 FIT-RB 成功的影响因素以及适合该成像技术的 ICG 浓度。53 例入组病例的良好成像率为 35.8%。差组 ENBD 前和腹腔镜胆囊切除术前的胆红素水平明显高于优组(P<0.001)。优组中 ICG 浓度较高(0.5mg/mL)的比例明显较高(P=0.028)。结果表明,在 ICG 浓度为 0.5mg/ml 时,良好成像的成功率是低剂量 ICG(0.125 或 0.25mg/L)的 4.53 倍。总胆红素和直接胆红素水平与成像效果呈负相关,总胆红素和直接胆红素水平是 FIT-RB 疗效的重要预测因素。对于低胆红素水平的患者,FIT-RB 是安全可行的。ICG 浓度为 0.5mg/ml 可能是实施该技术的理想选择。
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