Chartkitchareon Anuwat, Tullavardhana Thawatchai
Department of Surgery, Faculty of Medicine, Srinakharinwirot University, Ongkharak, 26120, Nakhon Nayok, Thailand.
Sci Rep. 2025 Jul 2;15(1):22566. doi: 10.1038/s41598-025-00991-7.
Laparoscopic cholecystectomy (LC) is the standard treatment for gallstone-related diseases, but bile duct injury remains a significant complication. This study investigates the efficacy of integrating the Critical View of Safety (CVS) and Indocyanine Green (ICG) fluorescent cholangiography to prevent bile duct injury. A retrospective study was conducted on 50 patients with cholelithiasis and gallstone-related complications who underwent LC at Srinakharinwirot University from April 2022 to April 2024. ICG (2.5 mg) was administered intravenously 60 min prior to surgery. LC was performed using a near-infrared light source. Statistical analysis included Chi-squared, unpaired t-tests, and logistic regression, with a significance level at p < 0.05. CVS was established in 78% of cases. Most cholecystectomies were complete (88%), no major bile duct injuries were reported. Visualization rates for the common bile duct (100%). Patients with gallbladder inflammation or previous history of ERCP had lower visualization rates, but these differences were not statistically significant. The non-CVS group had significantly longer operative times (75.9 vs. 60.5 min; p < 0.001) and higher rates of incomplete cholecystectomy (54.5% vs. 0%; p < 0.001) than the CVS established group. Integrating CVS and ICG fluorescent cholangiography enhances the safety of LC by improving bile duct visualization and reducing the risk of bile duct injury.
腹腔镜胆囊切除术(LC)是治疗胆结石相关疾病的标准方法,但胆管损伤仍然是一种严重的并发症。本研究探讨了结合安全关键视野(CVS)和吲哚菁绿(ICG)荧光胆管造影术预防胆管损伤的疗效。对2022年4月至2024年4月在诗纳卡琳威洛大学接受LC治疗的50例胆结石及胆结石相关并发症患者进行了一项回顾性研究。在手术前60分钟静脉注射ICG(2.5毫克)。使用近红外光源进行LC手术。统计分析包括卡方检验、非配对t检验和逻辑回归,显著性水平为p < 0.05。78%的病例建立了CVS。大多数胆囊切除术是完整的(88%),未报告重大胆管损伤。胆总管的可视化率为100%。有胆囊炎或既往ERCP病史的患者可视化率较低,但这些差异无统计学意义。与建立CVS的组相比,非CVS组的手术时间明显更长(75.9分钟对60.5分钟;p < 0.001),不完全胆囊切除术的发生率更高(54.5%对0%;p < 0.001)。结合CVS和ICG荧光胆管造影术可通过改善胆管可视化和降低胆管损伤风险来提高LC的安全性。