吲哚菁绿荧光导航在肥胖患者行腹腔镜胆囊切除术中的应用

Indocyanine green fluorescence navigation in obese patients undergoing laparoscopic cholecystectomy

目的探讨肥胖患者行腹腔镜胆囊切除术(LC)时直接静脉注射吲哚菁绿进行荧光胆囊胆管显影的可行性和潜力。方法回顾性分析2023年1月—2023年7月南京医科大学附属常州市第二人民医院肝胆胰外科收治的132例肥胖患者行LC的临床资料。按照是否使用吲哚菁绿荧光导航分为荧光组(n=65)和对照组(n=67)。其中男性50例,女性82例,所有入组患者均体重指数≥28 kg/m^(2)。分别统计荧光组和对照组的两组辨清三管时间、术中出血量、手术时间、术后住院时间、术前及术后第一次复查的白细胞计数(WBC)、C反应蛋白(CRP)、丙氨酸转氨酶(ALT)、谷氨酰转移酶(GGT)、术后随访等结果。偏态分布的计量资料以M(Q_(1),Q_(3))表示,组间比较采用Mann-WhitneyU检验;计数资料采用频数(率)描述,根据最小频数不同应用χ^(2)检验、Fisher精确概率法及卡方校正检验进行组间比较。结果两组患者均成功完成手术。术前炎症指标及肝功能水平也无统计学意义(P>0.05)。荧光组辨清三管时间、手术时间、术中出血量、术后住院时间分别为18.00(13.50,20.00)min、40.00(30.00,50.00)min、5.00(5.00,10.00)mL、2.00(1.50,3.00)d,对照组分别为32.00(25.00,45.00)min、65.00(50.00,85.00)min、41.00(41.00,46.00)mL、4.00(3.00,5.00)d,两组相比差异均有统计学意义(P<0.05)。荧光组术后WBC、CRP、GGT分别为9.15(7.10,11.75)×10^(9)/L、7.19(3.22,20.00)mg/L、34.0(20.0,49.0)U/L,对照组分别为13.05(11.02,15.59)×10^(9)/L、18.78(12.90,32.95)mg/L、82.5(68.5,114.5)U/L,两组相比差异均有统计学意义(P<0.05)。患者术后2个月内的随访调查结果均未出现腹痛、肝功能及肝胆彩超异常情况。结论肥胖这项因素对吲哚菁绿荧光的干扰影响是极为有限的,吲哚菁绿荧光胆管造影在肥胖人群中是一种有用的技术,不仅提高了手术效率,而且增加了术中的安全性,效果优于常规腹腔镜胆囊切除术。

Objective:To investigate the feasibility and potential of fluorescent cholecystic bile duct visualization with direct intravenous injection of indocyanine green(ICG)in obese patients undergoing laparoscopic cholecystectomy(LC).Methods:The clinical data of 132 patients with LC combined with obesity admitted to the Department of Hepatobiliary and Pancreatic Surgery of the Second People′s Hospital of Changzhou City,affiliated to Nanjing Medical University,from January 2023 to July 2023 were retrospectively analyzed.They were divided into fluorescence group(n=65)and control group(n=67)according to whether indocyanine green fluorescence navigation was used or not.There were 50 males and 82 females,and all the enrolled patients body mass index≥28 kg/m^(2).Two groups identify the time of the three tubes,intraoperative bleeding,operation time,postoperative hospitalization time,white blood cell count(WBC),C-reactive protein(CRP),alanine aminotransferase(ALT),gamma-glutamyl transferase(GGT),and postoperative follow-up in the fluorescent and control groups were counted respectively.Measurement data with skewed distribution were expressed as M(Q_(1),Q_(3)),and intergroup comparisons were performed using the Mann-Whitney U test;counting data were described by frequency(rate),and intergroup comparisons were made by applying the chi-square test,Fisher′s exact probability method,and chi-square corrected test according to the difference in the minimum frequency.Results:Surgery was successfully completed in both groups.Preoperative inflammatory indicators and liver function levels were also not statistically significant(P>0.05).The time to identify the three tubes,operation time,intraoperative bleeding,and postoperative hospitalization in the fluorescence group were 18.00(13.50,20.00)min,40.00(30.00,50.00)min,5.00(5.00,10.00)mL,and 2.00(1.50,3.00)d,and in the control group were 32.00(25.00,45.00)min,65.00(50.00,85.00)min,41.00(41.00,46.00)mL,and 4.00(3.00,5.00)d.The differences between the two groups were statistically significant(P<0.05).The postoperative leukocyte count,postoperative CRP,and postoperative GGT were 9.15(7.10,11.75)×10^(9)/L,7.19(3.22,20.00)mg/L,and 34.0(20.0,49.0)U/L in the fluorescence group,and 13.05(11.02,15.59)×10^(9)/L,and 18.78(12.90,32.95)mg/L in the control group,respectively,82.5(68.5,114.5)U/L,and the differences between the two groups were statistically significant(P<0.05).None of the patients showed abdominal pain,abnormal liver function and hepatobiliary ultrasound in the follow-up findings within 2 months after surgery.Conclusion:The effect of obesity,a factor that interferes with ICG fluorescence,is extremely limited,and ICG fluorescence cholangiography is a useful technique in the obese population that not only improves the efficiency of the procedure,but also increases intraoperative safety,with results superior to those of conventional laparoscopic cholecystectomy.