吲哚菁绿荧光胆道成像技术在胆囊切除术中应用的荟萃分析

Indocyanine green cholangiography applications in cholecystectomy:a meta-analysis

目的评价荧光胆道成像技术在胆囊切除术中应用的有效性和安全性。方法以腹腔镜、腹腔镜胆囊切除术、胆囊切除术、吲哚菁绿、荧光染料、近红外、胆道造影、荧光胆道造影、近红外成像、胆道可视化、术中胆道造影、laparoscopic、laparoscopic cholecystectomy、indocyanine green、ICG、fluorescent dyes、cholangiography、indocyanine green cholangiography、near-infrared、near-infrared imaging、biliary tract visualization、intraoperative cholangiography为检索词,在PubMed、Web of Science、the Cochrane Library、中国生物医学文献数据库、中国知网数据库、万方数据库和超星数据库进行文献检索。检索日期范围为从建库至2019年12月。3位作者独立进行文献检索、资料提取并采用纽卡斯尔-渥太华量表进行质量评价。采用Rev Man 5.3软件进行分析。对研究中的连续性变量及二分类变量分别采用均数差(mean difference,MD)及优势比(odds ratio,OR)为效应指标计算合并值及95%CI,以P<0.05为差异有统计学意义。并用Mantel-Haenszel检验法对研究进行异质性检验,以I2表示各研究之间的异质性。结果经筛选后共纳入9篇研究,包括935例患者。荟萃分析显示,在胆囊切除术中,与传统组相比,荧光胆道成像组识别胆道结构时间(MD=-7.35,95%CI:-9.70^-5.00,P<0.05)与手术时间(MD=-7.35,95%CI:-13.86^-0.83,P<0.05)均明显缩短,造影成功率(OR=2.98,95%CI:1.49~5.95,P<0.05)明显提高。然而在术中出血、中转开腹率、住院时间、总体并发症发生率方面差异均无统计学意义(P>0.05)。结论吲哚菁绿荧光胆道成像为胆囊切除术中胆道显影提供了一种新途径,而且安全可行。

Objective To investigate the clinical efficacy and safety of indocyanine green cholangiography in cholecystectomy.Methods"腹腔镜,腹腔镜胆囊切除术,胆囊切除术,吲哚菁绿,荧光染料,近红外,胆道造影,荧光胆道造影,近红外成像,胆道可视化,术中胆道造影,laparoscopic,laparoscopic cholecystectomy,indocyanine green,ICG,fluorescent dyes,cholangiography,indocyanine green cholangiography,near-infrared,near-infrared imaging,biliary tract visualization,and intraoperative cholangiography"are search terms,which are listed in PubMed,Web of Science,the Cochrane Library,CBM Database,CNKI Database,Wanfang Database and Superstar Database.The search date ranges from the establishment of the database to December 2019.Three authors did the literature search,data extraction independently,and used the Newcastle-Ottawa scale for quality evaluation.Rev Man 5.3 software was used for analysis.For continuous variables and binary variables in the study,mean difference(MD)and odds ratio(OR)were used as the effect indicators to calculate the combined value and 95%CI,and P<0.05 was used as the statistical difference.The Mantel-Haenszel test was used to investigate the heterogeneity of the studies,and I2 was used to represent the heterogeneity between the studies.Results A total of 9 studies from 935 patients were included.The results of meta-analysis showed that in cholecystectomy,compared with the traditional group,the recognition time of bile duct structure(MD=-7.35,95%CI:-9.70--5.00,P<0.05)and operation time(MD=-7.35,95%CI:-13.86--0.83,P<0.05)were significantly shorter,and the success rate of angiography(OR=2.98,95%CI:1.49-5.95,P<0.05)were significantly improved.There were no significant differences in bleeding,conversion to open,hospital stay,overall complication rate.Conclusion Indocyanine green fluorescence cholangiography not only provides a new way for cholangiography in cholecystectomy,but also is safe and feasible.