吲哚菁绿胆道显影技术在老年坏疽性胆囊炎手术中的应用研究

Indocyanine green bile duct visualization technique in surgery for gangrenous cholecystitis in the elderly

目的探讨吲哚菁绿胆道显影技术在老年坏疽性胆囊炎行腹腔镜胆囊切除术(Laparoscopic cholecystectomy,LC)中的应用价值。方法回顾性分析2020年1月-2022年7月笔者所在医院肝胆胰外科收治的98例诊断为老年坏疽性胆囊炎的患者资料,术前所有患者均经临床资料及影像学明确诊断。实验组在吲哚菁绿胆道显影下行LC,对照组在白光下行常规LC。记录并比较两组患者术前基本临床资料,术中肝外胆管识别率、完全暴露胆囊三角时间、手术时间、术中出血量及中转开腹例数,术后排气时间、术后拔管时间、住院时间、并发症、手术前后实验室指标及随访相关情况。结果两组患者均成功完成手术,实验组无中转开腹,对照组中转开腹1例。初步解剖胆囊三角区组织前,实验组和对照组胆总管识别率为92.3%和32.6%、实验组和对照组肝总管识别率为88.5%和30.4%、实验组和对照组胆囊管识别率为73.1%和23.9%,差异均有统计学意义(P<0.05)。实验组和对照组完全暴露胆囊三角时间分别为(27.50±3.56)min和(38.43±2.35)min、手术时间分别为(52.12±7.56)m in和(70.76±6.66)m in、术中出血量分别为(15.19±6.02)mL和(35.65±9.1)mL,差异均有统计学意义(P<0.05)。实验组和对照组术后排气时间分别为(15.42±3.36)h和(23.37±2.14)h、术后拔管时间分别为(2.17±0.68)d和(3.26±1.10)d、住院时间分别为(3.94±0.89)d和(5.41±0.96)d,差异均有统计学意义(P<0.05)。实验组和对照组术后C反应蛋白分别为(8.64±3.81)mg/L和(12.16±2.71)mg/L、实验组和对照组白细胞计数水平分别为(7.70±1.52)×10^(9)/L和(9.52±3.02)×10^(9)/L,差异均有统计学意义(P<0.05)。两组患者出院后随访未诉明显不适。结论面对老年坏疽性胆囊炎行LC时吲哚菁绿胆道显影技术能实时可视化肝外胆道结构,其能提高手术进度和安全性,减少手术打击,使老年患者更早恢复机体功能以达到快速康复。

Objective To investigate the application value of indocyanine green bile duct contrast technique in laparoscopic cholecystectomy(LC)for geriatric gangrenous cholecystitis.Methods The data of 98 patients diagnosed with gangrenous cholecystitis in the elderly admitted to the Department of Hepatobiliary and Pancreatic Surgery,Changzhou Second People's Hospital,Nanjing Medical University,from January 2020 to July 2022,were retrospectively analyzed.All patients were clearly diagnosed by clinical data and imaging before surgery.In the experimental group,LC was performed under indocyanine green bile duct visualization,and in the control group,conventional LC was performed under white light.Preoperative basic clinical data,intraoperative extrahepatic bile duct identification rate,time of complete exposure of gallbladder triangle,operation time,intraoperative bleeding and number of cases of intermediate open abdomen,postoperative venting time,postoperative extubation time,hospitalization time,complications,pre-and post-operative laboratory indexes and follow-up-related conditions were recorded and compared between the two groups.Results Both groups of patients successfully completed the surgery,with no intermediate openings in the experimental group and one intermediate opening in the control group.Before initial dissection of the gallbladder triangle tissue,the identification rates for common bile duct were 92.3%and 32.6%in the experimental group and control group,88.5%and 30.4%for common hepatic duct in the experimental group and control group,and 73.1%and 23.9%for cystic duct in the experimental group and control group,respectively,with statistically significant differences(P<0.05).The time to fully expose the gallbladder triangle was(27.50±3.56)min and(38.43±2.35)min,the operative time was(52.12±7.56)min and(70.76±6.66)min,and the intraoperative bleeding was(15.19±6.02)ml and(35.65±9.1)ml in the experimental and control groups,respectively,and the differences were statistically significant(P<0.05).The postoperative exhaust time was(15.42±3.36)h and(23.37±2.14)h,the postoperative extubation time was(2.17±0.68)d and(3.26±1.10)d,and the hospitalization time was(3.94±0.89)d and(5.41±0.96)d in the experimental and control groups,respectively,and the differences were statistically significant(P<0.05).The postoperative C-reactive protein was(8.64±3.81)mg/L and(12.16±2.71)mg/L,and the white blood cell count levels were(7.70±1.52)×10^(9)/L and(9.52±3.02)×10^(9)/L in the experimental and control groups,respectively,and the differences were statistically significant(P<0.05).Patients in both groups did not complain of significant discomfort during post-discharge follow-up.Conclusion The indole green biliary tract visualization technique can visualize the extrahepatic biliary tract structure in real time when performing LC in geriatric gangrenous cholecystitis.And it can improve the progress and safety of the procedure,reduce the surgical blow,and enable the elderly patients to recover their organism function earlier for rapid recovery.