吲哚菁绿近红外线导航在腹腔镜胆囊切除术关键安全视野技术中的应用

Application of indocyanine green near-infrared navigation in critical view of safety technique of laparoscopic cholecystectomy

目的:探讨术中吲哚菁绿(ICG)近红外线导航在腹腔镜胆囊切除术(LC)中实施关键安全视野(CVS)技术的应用价值。方法:选取2020年7月至2021年1月行LC的77例患者,将患者随机分为对照组(n=41)与研究组(n=36),对照组采用常规白光视野下CVS技术,研究组采用ICG近红外光导航下CVS技术。对比分析两组患者相关指标。结果:两组均成功施行LC,无中转开腹、胆管损伤病例,对照组中1例发生胆漏,保守治疗后治愈。对照组与研究组手术时间[(58.3±29.6)min vs.(47.4±16.9)min]、术中出血量[(13.5±9.2)mL vs.(9.6±4.5)mL]、术后住院时间[(7.9±1.8)d vs.(7.3±1.7)d]差异均无统计学意义(P>0.05)。术中初始状态下两组胆管显露程度为65.9%与88.9%,实施CVS技术后为78.0%与97.2%,差异有统计学意义(P<0.05)。结论:术中ICG近红外线导航下实施CVS技术较常规手术能更清晰地显示肝门区胆管结构的关系,并能观察胆漏的存在,对提高LC的安全性具有一定的临床意义。

Objective:To explore the application value of intraoperative indocyanine green(ICG)near-infrared navigation in the implementation of critical view of safety(CVS)technology in laparoscopic cholecystectomy.Methods:The clinical data of 77 patients who underwent laparoscopic cholecystectomy from Jul.2020 to Jan.2021 were analyzed.The patients were randomly divided into control group(n=41)and research group(n=36).The control group implemented CVS technology under conventional white light field of vision,while the research group underwent ICG near-infrared light navigation.The relevant clinical data of the two groups were collected for statistical analysis.Results:Both groups were successfully completed laparoscopic cholecystectomy.There were no cases of intraoperative conversion to laparotomy and bile duct injury.There was 1 case of bile leakage in the control group,which was cured after conservative treatment.There were no significant differences between the control group and the research group in the operation time[(58.3±29.6)min vs.(47.4±16.9)min],intraoperative blood loss[(13.5±9.2)mL vs.(9.6±4.5)mL],and postoperative hospital stay[(7.9±1.8)d vs.(7.3±1.7)d,P>0.05)].The degree of intraoperative bile duct exposure before CVS was 65.9%and 88.8%,and after CVS the degree was 78.0%and 97.2%,the difference was statistically significant(P<0.05).Conclusions:Compared with the conventional operations,the CVS technique under ICG near-infrared navigation during the operation can more clearly show the relationship between the hepatic hilar bile duct structures,and observe the existence of bile leakage.It has certain clinical significance for improving the safety of laparoscopic cholecystectomy.