Application of indocyanine green fluorescence imaging in complex laparoscopic cholecystectomy / 国际外科学杂志

ABSTRACT

Objective:To investigate the clinical value of indocyanine green(ICG) fluorescence imaging in complex laparoscopic cholecystectomy.Methods:The data of 96 patients with complicated gallbladder stones with cholecystitis and cholecystitis who underwent laparoscopic cholecystectomy(LC) from July 2018 to August 2020 in Hepatobiliary and Pancreatic Surgery of Huangshi Central Hospital of Edong Healthcare Group were retrospectively analyzed. Before operation, the patients were divided into experimental group( n=44) and control group( n=52) according to whether indocyanine green was injected intravenously. Seven hours before operation, the experimental group was injected with 2.5 mg indocyanine green, the experimental group underwent LC under guidance of ICG fluorescence imaging technology. The control group underwent conventional LC. The recognition rate of common bile duct and cystic duct, complete anatomy time of gallbladder triangle, operation time, intraoperative blood loss, bile duct injury and residual stone rat were compared. The measurement data obeying normal distribution was expressed by ( Mean± SD), and the t test was used comparison between groups, and the chi-square test or Fisher exact probability was used comparison between enumeration data. Results:The operation was successfully performed in both groups, In the control group, 1 case was converted to laparotomy, There was no perioperative death. Before the incision of the serosa of the triangle of the gallbladder, In the experimental group, the common bile duct recognition rate was 84.1%(37/44), the recognition rate of cystic duct was 72.7%(32/44). In the control group, the common bile duct recognition rate was 26.9%(14/52), the recognition rate of cystic duct was 28.8% (15/52). There were statistically significant differences in the recognition rate of common bile duct and cystic duct between the two groups ( P< 0.05). In experimental group, the time of complete dissection of gallbladder triangle, the operation time, the intraoperative blood loss were (30.2±8.6) min, (48.2±9.8) min, (16.3±5.2) mL, and (46.7±13.9) min, (65.2±15.4) min, (26.1±11.3) mL in the control group, there were statistically significant difference in the above indicators between experimental group and control group( P<0.05). There was no extrahepatic bile duct injury and residual stones in the experimental group. In the control group, there was 1 case of right posterior hepatic duct injury, 2 cases of common bile duct injury and 1 case of residual gallstone. There was no significant difference in extrahepatic bile duct injury and postoperative stone residual rate between the two groups ( χ2=3.532, P=0.081). Conclusion:ICG fluorescence navigation is helpful for early identification of common bile duct and cystic duct in laparoscopic complex cholecystectomy, which can avoid iatrogenic bile duct injury and has good clinical value.