吲哚菁绿荧光胆道造影技术应用于困难型腹腔镜胆囊切除术的Meta分析

A meta-analysis of indocyanine green fluorescent cholangiography applied in difficult laparoscopic cholecystectomy

目的:评价吲哚菁绿荧光胆道造影技术应用于困难型腹腔镜胆囊切除术的有效性。方法:检索中国知网、维普数据库、PubMed、Web of Science等数据库建库至2023年6月的相关文献,按照纳入与排除标准进行筛选后,对纳入的文献进行资料提取与质量评价,采用RevMan 5.4软件进行Meta分析。结果:共纳入24篇文献。Meta分析结果显示,吲哚菁绿组识别胆道结构时间(MD=-14.28,95%CI=-19.42~-9.14,P<0.05)、手术时间(MD=-19.56,95%CI=-24.39~-14.72,P<0.05)、术后住院时间(MD=-0.69,95%CI=-1.03~-0.36,P<0.05)、术后引流时间(MD=-0.78,95%CI=-1.17~-0.38,P<0.05)短于传统组,胆管损伤率(OR=0.22,95%CI=0.11~0.44,P<0.05)、中转开腹率(OR=0.40,95%CI=0.22~0.72,P<0.05)、术后并发症发生率(OR=0.42,95%CI=0.28~0.65,P<0.05)低于传统组,术中失血量(MD=-17.97,95%CI=-24.67~-11.26,P<0.05)少于传统组,解剖前肝总管(OR=8.41,95%CI=4.65~15.21,P<0.05)、胆囊管(OR=4.21,95%CI=2.80~6.33,P<0.05)、胆总管(OR=9.64,95%CI=6.02~15.44,P<0.05)识别率均高于传统组。结论:吲哚菁绿荧光胆道造影技术为困难的腹腔镜胆囊切除术提供了新的胆道显影方式,可提高手术安全性,减少术中副损伤及术后并发症的发生。

Objective:To evaluate the effectiveness of indocyanine green(ICG)fluorescence cholangiography in difficult laparoscopic cholecystectomy(LC).Methods:Relevant literatures were retrieved from databases such as China national knowledge infrastructure,VIP,PubMed,and Web of Science from their establishment until Jun.2023.After screening according to inclusion and exclusion criteria,data extraction and quality evaluation of the included literatures,meta-analysis was performed using RevMan 5.4 statistical software.Results:A total of 24 studies were included in the meta-analysis.The meta-analysis results showed that compared with the conventional group,the ICG group in difficult LC had significantly shorter time for identification of biliary structure(MD=-14.28,95%CI=-19.42~-9.14,P<0.05),shorter operation time(MD=-19.56,95%CI=-24.39~-14.72,P<0.05),shorter postoperative hospital stay(MD=-0.69,95%CI=-1.03~-0.36,P<0.05),shorter postoperative drainage time(MD=-0.78,95%CI=-1.17~-0.38,P<0.05),lower incidence of bile duct injury(OR=0.22,95%CI=0.11~0.44,P<0.05),lower rate of conversion to open surgery(OR=0.40,95%CI=0.22-0.72,P<0.05),lower incidence of postoperative complications(OR=0.42,95%CI=0.28~0.65,P<0.05),less intraoperative blood loss(MD=-17.97,95%CI=-24.67~11.26,P<0.05),and higher identification rates of the common hepatic duct(OR=8.41,95%CI=4.65~15.21,P<0.05),cystic duct(OR=4.21,95%CI=2.80~6.33,P<0.05),and common bile duct(OR=9.64,95%CI=6.02~15.44,P<0.05)before anatomy.Conclusions:ICG fluorescence cholangiography provides a new method for biliary visualization in the difficult LC.It has the potential to improve the safety of difficult LC and reduce the incidence of intraoperative side-injury and postoperative complications.