Résumé
Objective:To analyze the clinical value of indocyanine green (ICC) fluorescence imaging in Mirizzi syndrome type Ⅱ-Ⅲ laparoscopic cholecystectomy (LC).Methods:A retrospective analysis was performed on 80 patients diagnosed with Mirizzi syndrome types Ⅱ-Ⅲ who underdoing LC in Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from October 2018 to February 2022, including 32 males and 48 females, aged (63.5±6.9) years. Patients were divided into two groups based on whether ICG fluorescence imaging technology was used, the control group ( n=38) that patients were treated with conventional LC and the experimental group ( n=42) patients were treated with LC guided by ICG fluorescence imaging. In the experimental group, the extrahepatic bile duct was identified by ICG fluorescence imaging during LC, and ICG was injected intraoperally to determine the reserved blood flow of gallbladder flap for fluorescence imaging and determine the resection line. Operation time, intraoperative blood loss, conversion rate of laparotomy and postoperative complications (bile leakage, incision infection, etc.) were compared between the two groups. Intraoperative fluorescence imaging and determination of the modified resection line of reserved gallbladder were analyzed in the observation group. Results:There was no significant difference in age, male proportion, type of Mirizzi syndrome and conversion rate of laparotomy between the two groups (all P>0.05). In the observation group, the operative time was (208.7±32.0) min, the intraoperative blood loss was (50.5±23.8) ml, and the biliary leakage was 7.1% (3/42), which was lower than that in the control group (228.2±33.9) min, (73.8±31.0) ml, 26.3% (10/38). The differences were statistically significant (all P<0.05). Of 37 cases (88%) showed common hepatic duct and common bile duct successfully in the observation group. In the observation group, ICG fluorescence imaging was used to determine the gallbladder resection line in 8 cases (19.0%). The gallbladder flap without fluorescence imaging was removed. Conclusion:ICG fluorescence imaging in LC for Mirizzi syndrome patients can identify the common bile duct and hepatic duct to guide surgical resection, determine the gallbladder flap resection line, reduce postoperative bile leakage and bleeding, and accelerate the surgical progress.
Résumé
Objective:To explore the clinical value of indocyanine green (ICG) fluorescence imaging technology in complex laparoscopic cholecystectomy (LC) for real-time imaging of extrahepatic bile ducts to avoid bile duct damage.Methods:The data of 90 patients with complicated gallbladder stones with cholecystitis who underwent LC from November 2018 to May 2019 at Liaoning University of Traditional Chinese Medicine Affiliated Hospital were studied. The patients were divided into the control group and the experimental group based on different imaging methods. The control group underwent conventional LC, and the experimental group underwent LC under guidance of ICG fluorescence imaging technology. ICG 5 mg were injected into a peripheral vein (elbow vein) 12 hours before operation. The pre-LC common bile duct, common hepatic duct and cystic duct recognition rates, time to establish gallbladder triangle, intraoperative blood loss, bile duct injuries and postoperative complications were determined.Results:Of the 45 patients in the experimental group, there were 18 males and 27 females. The age was (60.9±9.3) years. The body mass index (BMI) was (26.2±2.0) kg/m 2. Of the 45 patients in the control group, there were 23 males and 22 females. The age was (57.5±8.7) years. The BMI was (26.7±2.7) kg/m 2. There were no significant differences in the clinical data between the two groups ( P>0.05). In the experimental group, the common bile duct was successfully shown in 40 patients (88.9%) and the cystic duct in 34 patients (75.6%). In the control group, the common bile duct was shown in 13 patients (28.9%) and the cystic duct in 12 patients (26.7%). The time taken for the experimental group to establish the triangle of gallbladder was (33.4±9.0) min. The corresponding time for the control group was (52.7±15.0) min. The intraoperative blood loss was (15.5±5.4) ml in the experimental group and (23.0±15.6) ml in the control group. One patient in the control group, but no patients in the experimental group, had to be converted to laparotomy. The control group had 1 right hepatic duct injury and 1 common bile duct injury. Each group had 1 patient with a sub-xiphoid incision infection. No additional complications were detected after a follow-up of 3 months. The differences in pre-LC common bile duct, common hepatic duct, and cystic duct recognition rates, time to establish the gallbladder triangle, and intraoperative blood loss were significantly different between the two groups ( P<0.05). There were no significant differences in biliary tract injuries and postoperative complications rates ( P>0.05). Conclusion:Early observation of the cystic duct and common bile duct with ICG fluorescence imaging in complex LC can help prevent common bile duct damage and speed up the progress of surgery.
Résumé
Objective To investigate the treatment of Fuwei decoction for the prevention of gastric precancerous lesions and to elucidate the possible mechanism and medical effect underlying the activity.Methods A total of 140 rats with gastric precancerous lesions were utilized through traditional Chinese medicine (CM) and Western medicine prevention and treatment,in order to observe the various clinical changes of gastric mucosal pathology and Caspase-3.Results The results showed that the incidence of atypical hyperplasia treated by TCM group was 50.0％ (6/12) and that by western medicine prevention group was 42.86％ (6/14),which was significantly lower than gastric mucosal rebuilding group [90.0％ (9/10)](H =16.40,H =16.86,p＜0.05).Compared with gastric mucosal rebuilding gap group 90.9 ％(10/11)(H =12.39,H =12.18,P ＜0.05),the incidence of atypical hyperplasia (A&H) underlying TCM group and western medicine prevention group were 42.9％(6/14)and 41.7％ (5/12),respectively,which much of them was further confirmed as mild and moderate A&H [45.45％ (6/11),36.36 ％(4/11)].Furthermore,also it was found that all the groups,turn out to express with obvious rate discrepancy underlying Caspase-3 as:(1) the rate of gastric mucosal rebuilding group was lower than regular comparison group (q =3.05,P ＜0.01); (2) the rate of TCM group & western medicine prevention group is much higher than gastric mucosal rebuilding group & regular comparison group (q =5.45,q =7.54,q =8.51,q =10.60,P ＜0.01); (3) the rate of TCM group & western medicine treatment group is also rather higher than gastric mucosal rebuilding gap group & regular comparison group (q =15.66,q =18.53,q =15.66,q =18.53,P ＜0.01).Conclusion The findings of the current study illustrate that the Fuwei decoction has a protective & preventive effect on gastric precancerous.which is against the atypical hyperplasia on gastric epithelial cells underlying Caspase-3.