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腹腔镜胆囊切除术中经胆囊内注射与静脉注射吲哚菁绿(ICG)用于荧光胆管造影增强胆管可视化的回顾性队列研究

Intragallbladder versus intravenous indocyanine green (ICG) injection for enhanced bile duct visualization by fluorescent cholangiography during laparoscopic cholecystectomy: a retrospective cohort study.

作者信息

Cai Yu, Chen Qiangxing, Cheng Ke, Chen Zixin, Wu Shangdi, Wu Zhong, Wang Xin, Li Yongbin, Balla Andrea, Singh Anurag, Cai He, Gao Pan, Cai Yunqiang, Peng Bing

机构信息

Division of Pancreatic Surgery, Department of General Surgery, West China Hospital of Sichuan University, Chengdu, China.

Department of General Surgery, Nanchong Central Hospital, The Second Clinical College of North Sichuan Medical College, Nanchong, China.

出版信息

Gland Surg. 2024 Sep 30;13(9):1628-1638. doi: 10.21037/gs-24-198. Epub 2024 Sep 27.

DOI:10.21037/gs-24-198
PMID:39421052
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11480876/
Abstract

BACKGROUND

Iatrogenic bile duct injuries (BDIs) prevention during laparoscopic cholecystectomy (LC) relies on meticulous anatomical dissections through direct visualization. Near-infrared fluorescence (NIRF) with indocyanine green (ICG) improves the visualization of extrahepatic biliary structures. Although ICG can be administered either intravenously or intragallbladder, there remains uncertainty regarding the optimal method for different patient populations. This study sought to assess the suitability of each method for specific patient groups.

METHODS

Between October 2021 and May 2022, 59 consecutive patients underwent fluorescence-guided LC at West China Hospital of Sichuan University. Among them, 32 patients received an intravenous injection of ICG (10 mg) 10 to 12 hours prior to surgery (Group A: the intravenous group), while 27 patients received an intragallbladder injection of ICG (10 mg) (Group B: the intragallbladder group). Baseline clinical factors, inclusion criteria, and measurements of parameters and complications were assessed. Data were retrospectively collected and analyzed to evaluate the comparability of the two groups and the clinical outcomes.

RESULTS

Groups A and B included 32 patients (18 males, 14 females), and 27 patients (13 men, 14 women), respectively. In our statistical analysis, significant differences were observed in preoperative diagnoses between the two groups (P=0.041), but the majority of other baseline clinical factors were comparable. Notably, no statistically significant differences were found in complication rates. However, Group A had a shorter operative time (60.38±9.35 66.78±9.88 min, P=0.01) and superior bile duct fluorescence (P=0.04) than Group B. Interestingly, fluorescence was not observed in impacted gallbladder stones in Group B. Additionally, patients with cirrhosis (P=0.008) and fatty liver (P=0.005) in Group B had higher common bile duct-to-liver ratios (BLRs) than those in Group A.

CONCLUSIONS

ICG fluorescence cholangiography allows to visualize extrahepatic biliary anatomical structures with both administration methods. However, the efficacy of bile duct fluorescence varies with different administration routes in diverse patient populations. Hence, appropriate administration route selection for ICG should be tailored to individual patients.

摘要

背景

腹腔镜胆囊切除术(LC)期间医源性胆管损伤(BDI)的预防依赖于通过直接可视化进行细致的解剖分离。吲哚菁绿(ICG)近红外荧光(NIRF)可改善肝外胆管结构的可视化。尽管ICG既可以静脉注射也可以胆囊内注射,但对于不同患者群体的最佳给药方法仍存在不确定性。本研究旨在评估每种方法对特定患者群体的适用性。

方法

2021年10月至2022年5月期间,四川大学华西医院连续59例患者接受了荧光引导下的LC。其中,32例患者在手术前10至12小时接受静脉注射ICG(10mg)(A组:静脉注射组),而27例患者接受胆囊内注射ICG(10mg)(B组:胆囊内注射组)。评估基线临床因素、纳入标准以及参数和并发症的测量。回顾性收集和分析数据,以评估两组的可比性和临床结果。

结果

A组和B组分别包括32例患者(18例男性,14例女性)和27例患者(13例男性,14例女性)。在我们的统计分析中,两组术前诊断存在显著差异(P = 0.041),但大多数其他基线临床因素具有可比性。值得注意的是,并发症发生率未发现统计学显著差异。然而,A组的手术时间比B组短(60.38±9.35对66.78±9.88分钟,P = 0.01),胆管荧光也优于B组(P = 0.04)。有趣的是,B组的嵌顿胆囊结石未观察到荧光。此外,B组中肝硬化患者(P = 0.008)和脂肪肝患者(P = 0.005)的胆总管与肝脏比值(BLR)高于A组。

结论

两种给药方法下,ICG荧光胆管造影均可使肝外胆管解剖结构可视化。然而,胆管荧光的效果在不同患者群体中因给药途径不同而有所差异。因此,ICG的给药途径选择应根据个体患者进行定制。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/666f/11480876/6dc1c27bb70b/gs-13-09-1628-vidS.2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/666f/11480876/b0a7982c3b75/gs-13-09-1628-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/666f/11480876/1b9254995553/gs-13-09-1628-f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/666f/11480876/2481bafd9498/gs-13-09-1628-f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/666f/11480876/242a031ada72/gs-13-09-1628-vidS.1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/666f/11480876/6dc1c27bb70b/gs-13-09-1628-vidS.2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/666f/11480876/b0a7982c3b75/gs-13-09-1628-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/666f/11480876/1b9254995553/gs-13-09-1628-f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/666f/11480876/2481bafd9498/gs-13-09-1628-f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/666f/11480876/242a031ada72/gs-13-09-1628-vidS.1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/666f/11480876/6dc1c27bb70b/gs-13-09-1628-vidS.2.jpg

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