吲哚菁绿在腹腔镜胆囊切除术中时间及剂量选择的研究进展

Research progress on time and dose selection of indocyanine green in laparoscopic cholecystectomy

在精准医疗兴起的时代,腹腔镜胆囊切除术(LC)相比于开腹手术,其优势在于创伤打击小、术后并发症少、住院时间短等,但却逃不过胆管损伤的风险,且因各种原因可致胆管损伤随时发生,其不可预见性使得手术难度大大提升。传统的胆管造影虽能规避胆管损伤,然因其使用耗时耗力、费用贵、辐射大等局限性而未被广泛运用。早期吲哚菁绿因其特性被广泛运用于淋巴结检查、血管造影、肿瘤定位及治疗等临床工作中。现吲哚菁绿荧光显影技术慢慢运用于LC中,其能动态反映术中情况,实现实时手术导航,故在辨清管道结构及预防胆管损伤中能取得理想效果。通过术前经静脉或术中经胆囊注射吲哚菁绿的方式显影肝外胆管,其明显提升了手术的安全率,然吲哚菁绿的使用时间及剂量尚无统一标准。本文结合研究现状和笔者单位经验对吲哚菁绿的时间和剂量选择及临床价值作一综述。

In the era of precision medicine,compared with open surgery,laparoscopic cholecystectomy has the advantages of less trauma,less postoperative complications and shorter hospital stay,but it cannot escape the risk of bile duct injury,and bile duct injury can occur at any time for various reasons,and its unpredictability greatly increases the difficulty of surgery.Although traditional cholangiography can avoid bile duct injury,it has not been widely used due to its limitations such as time consuming,high cost,high radiation and so on.Early indocyanine green has been widely used in lymph node examination,angiography,tumor localization and treatment due to its characteristics.Now,indocyane green fluorescence imaging technology has been gradually applied in LC,which can dynamically reflect the intraoperative situation and realize real-time surgical navigation,so it has achieved ideal effects in the identification of duct structure and prevention of bile duct injury.Indocyanine green injection preoperatively or intraoperatively through the gallbladder to develop extrahepatic bile ducts significantly improves the safety rate of surgery,but there is no unified standard for the use time and dosage of inddocyanine green.In this paper,the time and dose selection and clinical value of indocyanine green were reviewed based on the current research status and the author's experience.