吲哚菁绿荧光导航在开腹胆囊切除术中的应用

The application of indocyanine green fluorescent navigation in laparotomy of cholecystectomy

目的探究吲哚菁绿荧光导航在开腹胆囊切除术中的应用价值。方法选取遵义医学院第三附属医院肝胆胰腺外科2016年3月—2018年2月开腹胆囊切除术临时需术中肝外胆道造影的患者48例,采用随机数字表法将其分为对照组(24例)及试验组(24例),对照组使用常规X线胆管造影,试验组采用吲哚菁绿近红外线荧光成像肝外胆道造影,比较两组造影成功率、造影花费时间、造影经济成本、造影准确率、造影安全性,比较两组手术时间、术中出血量、输血量及住院时间、住院费用。结果两组造影成功率(98.6%比97.2%)、不良反应发生率(25.0%比29.2%)差异无统计学意义(P>0.05);试验组造影花费时间(25.7±3.5)min比(31.4±4.7)min、手术时间(90.2±10.3)min比(81.4±9.4)min、术中出血量(82.4±8.2)min比(78.1±7.8)min、输血量(35.2±4.8)min比(29.6±4.0)min及住院时间(7.6±1.5)d比6.2±1.3)d、住院费用(1.3±0.3)万元比(1.04±0.25)万元均显著低于对照组,试验组造影准确率(92.2%比87.5%)及胆管损伤判定灵敏度(85.7%比50.0%)、特异度(88.2%比68.8%)显著高于对照组,差异有统计学意义(P<0.05)。结论开腹胆囊切除术中临时造影,吲哚菁绿荧光导航较传统X线胆管造影更及时,准确,能有效缩短患者手术时间、术中出血量、输血量及住院时间、住院费用。且不会提高不良反应发生率,具有较高安全性,值得临床推广。

Objective To explore the application of indocyanine green fluorescence navigation in open cholecystectomy. Methods Forty-eight patients with extrahepatic cholangiography who underwent open cholecystectomy in our hospital from March 2016 to February 2018 were enrolled. They were divided into the control group (24 cases) and the experimental group (24 cases) by using the random number table method. The control group was treated with conventional X-ray cholangiopancreatography, and the experimental group was treated with indocyanine green near-infrared fluorescence imaging for extrahepatic cholangiography. The cholangiography success rate, cholangiography time, cholangiography economic costs, imaging accuracy and security were compared between two groups. The operation time, intraoperative blood loss, blood transfusion amount, length of hospital stays, and hospital expenses were also compared between two groups. Results The success rate of cholangiography (98.62% vs 97.22%) and the incidence of adverse reactions (25.00 vs 29.17) were not significantly different between the two groups (P>0.05). The cholangiography time (25.69±3.47 min vs 31.42±4.66 min), operation time (90.18±10.27 min vs 81.44±9.35 min), intraoperative blood loss (82.35±8.24 ml vs 78.14±7.82 ml), blood transfusion volume (35.19±4.77 ml vs 29.58±4.03 ml), hospitalization time (7.59±1.52 d vs 6.24±1.25 d), and hospitalization cost (12.7±3.1 thousands vs 10.4±2.5 thousands) of the experimental group were significant lower than those of the control group. The accuracy rate (92.22% vs 87.50%), sensitivity (85.71% vs 50.00%) and specificity (88.24% vs 68.75%) of cholangiography in the experimental group were significantly higher than those in the control group, with statistically significant differences (P<0.05). Conclusion Indocyanine green fluorescent navigation is more timely and accurate than traditional X-ray cholangiography during temporary angiography in open cholecystectomy, which can effectively shorten the operation time, intraoperative blood loss, blood transfusion, hospitalization time and hospitalization expenses. It does not increase the incidence of adverse reactions, has high safety, and is worthy of clinical promotion.