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诊断性腹腔镜检查联合吲哚菁绿荧光试验评估腹部钝性损伤时的肠灌注:一例报告

Diagnostic laparoscopy with indocyanine green fluorescence test for the evaluation of intestinal perfusion in abdominal blunt injury: a case report.

作者信息

Li Ze-Rui, Cheng Yi-Chiao, Hong Zhi-Jie

机构信息

Department of General Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.

Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.

出版信息

Int J Emerg Med. 2024 Aug 26;17(1):100. doi: 10.1186/s12245-024-00684-4.

Abstract

BACKGROUND

The indocyanine green (ICG) fluorescence test has become a standard test in surgical procedures, facilitating the assessment of blood perfusion in real-time. While its utility in emergency surgeries for evaluating anastomotic blood supply is well-established, its application in trauma cases, especially those involving mesenteric hematoma, remains underexplored. Herein, we present a case to illustrate the efficacy of the ICG fluorescence test in such scenarios.

CASE PRESENTATION

A 51-year-old man with uncontrolled hypertension suffered blunt abdominal trauma following a motor vehicle accident. We used the intra-operative ICG fluorescence test to chart the surgical plan for the patient. A combination of diagnostic laparoscopy with ICG fluorescence testing effectively excluded bowel ischemia, leading to the avoidance of intestinal resection and the need for a temporary ostomy. The patient resumed enteral nutrition.

CONCLUSIONS

Our case underscores the efficacy of ICG fluorescence testing in assessing bowel viability and guiding surgical strategies in trauma patients with mesenteric hematoma. By facilitating real-time visualization of blood perfusion, ICG testing enables the adoption of conservative treatments in patients who would traditionally require more invasive surgical interventions, with minimal effect on operation time and cost.

摘要

背景

吲哚菁绿(ICG)荧光测试已成为外科手术中的一项标准测试,有助于实时评估血液灌注情况。虽然其在急诊手术中评估吻合口血液供应的效用已得到充分证实,但其在创伤病例中的应用,尤其是涉及肠系膜血肿的病例,仍未得到充分探索。在此,我们展示一个病例以说明ICG荧光测试在这种情况下的有效性。

病例介绍

一名51岁患有高血压且血压控制不佳的男性在机动车事故后遭受钝性腹部创伤。我们使用术中ICG荧光测试为该患者制定手术方案。诊断性腹腔镜检查与ICG荧光测试相结合有效地排除了肠缺血,从而避免了肠切除以及临时造口的需要。患者恢复了肠内营养。

结论

我们的病例强调了ICG荧光测试在评估肠系膜血肿创伤患者肠活力和指导手术策略方面的有效性。通过促进血液灌注的实时可视化,ICG测试能够在传统上需要更具侵入性手术干预的患者中采用保守治疗,对手术时间和成本影响最小。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2ceb/11345953/fc47fb988c9e/12245_2024_684_Fig1_HTML.jpg

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