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整合安全的批判性观点与吲哚菁绿胆管造影术以提高腹腔镜胆囊切除术的安全性:一项回顾性横断面研究。

Integrating critical view of safety and indocyanine green cholangiography to enhance safety in laparoscopic cholecystectomy: a retrospective cross-sectional study.

作者信息

Chartkitchareon Anuwat, Tullavardhana Thawatchai

机构信息

Department of Surgery, Faculty of Medicine, Srinakharinwirot University, Ongkharak, 26120, Nakhon Nayok, Thailand.

出版信息

Sci Rep. 2025 Jul 2;15(1):22566. doi: 10.1038/s41598-025-00991-7.

Abstract

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.

摘要

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。

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