Pesce Antonio, Fabbri Nicolò, Bonazza Luca, Feo Carlo
Department of Surgery, Azienda Unità Sanitaria Locale Ferrara, University of Ferrara, Via Valle Oppio, Lagosanto, Ferrara, Italy.
Int J Surg. 2024 Dec 1;110(12):7775-7781. doi: 10.1097/JS9.0000000000002160.
Currently, there is limited scientific evidence regarding the effectiveness of fluorescent cholangiography in emergency cholecystectomy for acute cholecystitis. The primary aim of this study was to assess the efficacy of near-infrared fluorescent cholangiography (NIRF-C) in different severity degrees of acute cholecystitis.
Inclusion criteria were patients with a clinical and radiological (abdominal ultrasound and/or computed tomography) diagnosis of acute cholecystitis based on the revised 2018 Tokyo guidelines who underwent laparoscopic cholecystectomy within 24-72 h from the onset of symptoms and patients with ASA score of 0-3. NIRF-C was performed at three-time points during laparoscopic cholecystectomy: (i) following exposure of Calot's triangle, prior to any dissection; (ii) after partial dissection of Calot's triangle; and (iii) after complete dissection of Calot's triangle. The intraoperative severity degree of acute cholecystitis was assessed according to the American Association of Surgery for Trauma (AAST) classification.
NIRF-C was successfully performed in all 81 consecutive patients who underwent emergency laparoscopic cholecystectomy. The cystic duct was identified by NIRF-C in 46 (56.8%) and 77 (95.1%) of the 81 patients before and after Calot's dissection, respectively. The common hepatic duct and common bile duct were successfully identified in 11 (13.6%) and 32 patients (39.5%) before Calot's dissection, respectively, and in 45 (55.6%) and 76 patients (93.8%) after complete Calot's dissection, respectively. When comparing the visualization rate of biliary structures before and after Calot dissection in different severity degrees of cholecystitis, the authors found a statistically significant difference in nongangrenous (AAST I) versus gangrenous and complicated forms (AAST II-V) for all biliary structures, both before and after Calot's dissection.
The study indicates that the use of fluorescence cholangiography during emergency laparoscopic cholecystectomy for acute cholecystitis may represent a valuable and useful tool for intraoperative visualization of the extrahepatic biliary tract.
目前，关于荧光胆管造影术在急性胆囊炎急诊胆囊切除术中有效性的科学证据有限。本研究的主要目的是评估近红外荧光胆管造影术（NIRF-C）在不同严重程度急性胆囊炎中的疗效。
纳入标准为根据修订后的2018年东京指南，经临床和影像学（腹部超声和/或计算机断层扫描）诊断为急性胆囊炎，且在症状出现后24 - 72小时内行腹腔镜胆囊切除术的患者，以及ASA评分为0 - 3分的患者。在腹腔镜胆囊切除术中的三个时间点进行NIRF-C检查：（i）暴露胆囊三角后，在进行任何解剖之前；（ii）胆囊三角部分解剖后；（iii）胆囊三角完全解剖后。根据美国创伤外科学会（AAST）分类评估急性胆囊炎的术中严重程度。
所有81例连续接受急诊腹腔镜胆囊切除术的患者均成功进行了NIRF-C检查。在胆囊三角解剖前和解剖后，81例患者中分别有46例（56.8%）和77例（95.1%）通过NIRF-C识别出胆囊管。在胆囊三角解剖前，分别有11例（13.6%）和32例（39.5%）成功识别出肝总管和胆总管，在胆囊三角完全解剖后，分别有45例（55.6%）和76例（93.8%）成功识别。在比较不同严重程度胆囊炎患者胆囊三角解剖前后胆管结构的可视化率时，作者发现对于所有胆管结构，在胆囊三角解剖前后，非坏疽性（AAST I）与坏疽性及复杂性（AAST II - V）胆囊炎之间存在统计学显著差异。
该研究表明，在急性胆囊炎急诊腹腔镜胆囊切除术中使用荧光胆管造影术可能是术中可视化肝外胆道的一种有价值且有用的工具。
