吲哚青绿近红外荧光胆道造影指导腹腔镜胆囊切除术治疗胆囊结石患者疗效研究

Application of laparoscopic cholecystectomy under guidance of indocyanine greennear infrared fluorescence in treatment of patients with gallstones

目的探讨应用吲哚青绿(ICG)近红外荧光胆道造影指导腹腔镜胆囊切除术(LC)治疗胆囊结石患者的效果。方法2019年3月~2022年8月我院收治的胆囊结石患者172例,采用随机数字表法将患者分为两组,每组86例。在对照组,采用常规LC术;在观察组,采用ICG近红外荧光胆道造影下指导行LC术。随访,采用单因素和多因素Logistic回归分析LC术后发生并发症的影响因素。结果观察组手术时间、术中出血量和住院时间分别为(38.4±3.8)min、(65.1±6.4)mL和(4.6±0.4)d,均显著短于或少于对照组【分别为(49.7±4.7)min、(85.3±8.4)mL和(6.5±0.7)d,P<0.05】;随访发现,术后观察组并发症发生率为4.6%,显著低于对照组的15.1%,差异具有统计学意义(P<0.05);在172例患者中,术后发生并发症者17例,发生并发症组患者年龄大于60岁、体质指数大于≥27 kg/m^(2)、合并糖尿病、有慢性胆囊炎病史、术中出血量≥70 mL和未进行ICG胆道造影的比率分别为70.6%、52.9%、64.7%、94.1%、76.5%和0.0%,与未发生并发症组(分别为34.8%、27.7%、37.4%、62.6%、47.1%和72.9%)比,差异具有统计学意义(P<0.05);多因素Logistic回归分析显示,年龄、合并糖尿病、术中出血量和术中是否进行ICG近红外荧光胆道造影与LC术后发生并发症独立相关(P均<0.05)。结论采用ICG近红外荧光胆道造影指导行LC术治疗胆囊结石患者可减少术中出血量,降低术后并发症发生率,值得扩大临床验证。

Objective The aim of this study was to investigate the application of laparoscopic cholecystectomy(LC)under guidance of indocyanine green(ICG)near infrared fluorescence in treatment of patients with gallstones.Methods 172 patients with gallstones were consecutively encountered in our hospital between March 2019 and August 2022,and were randomly divided into two control and observation groups,with 86 cases in each group.The patients in the control group received routine LC,and those in the observation underwent LC under the guidance of ICG cholangiography.All patients after operation were followed-up and univariate and multivariate Logistic regression analysis was applied to reveal the impacting factors for complications after operation.Results The operation time,blood loss and hospitalization stay in the observation group were(38.4±3.8)min,(65.1±6.4)mL and(4.6±0.4)day,all significantly shorter or less than[(49.7±4.7)min,(85.3±8.4)mL and(6.5±0.7)day,respectively,P<0.05]in the control;the rate of post-operational complication,such as biliary injury,rupture of ductus cysticus,biliary infection,peritoneal infection and stone residue,in the observation group was 4.6%,much lower than 15.1%in the control(P<0.05);out the 172 patients with gallstone in our series,the post-operational complications occurred in 17 cases,and the elderly patients,obviously increased body mass index,concomitant diabetes mellitus,chronic cholecystitis history,relatively large amount of blood loss and no ICG radiography in the patients with complications were 70.6%,52.9%,64.7%,94.1%,76.5%and 0.0%,significantly different compared to 34.8%,27.7%,37.4%,62.6%,47.1%and 72.9%in patients without complications(P<0.05);the multivariate Logistic regression analysis showed that the ages,concomitant diabetes,blood loss and ICG radiography were the independent factors related to the occurrence of post-operational complications(all P<0.05).Conclusion The application of LC under the guidance of ICG near infrared fluorescence cholangiography in the treatment of patients with gallstone could reduce the amount of intraoperative blood loss and the incidence of postoperative complications,which warrants further clinical multi-central validation.