吲哚菁绿荧光导航在腹腔镜经胆囊管胆总管探查取石术中的临床应用

Application of indocyanine green fluorescence navigated laparoscopic transcystic common bile duct exploration

目的探讨吲哚菁绿荧光导航在腹腔镜经胆囊管胆总管探查取石术(LTCBDE)中的临床应用。方法回顾性分析2022年1月至2023年12月仙居县人民医院肝胆外科单个医疗组收治的62例接受腹腔镜手术的胆总管结石患者,其中20例行吲哚菁绿荧光导航LTCBDE(LTCBDE组),42例行腹腔镜胆总管探查取石+T管引流(LCBDE+T管组),比较两组患者围手术期临床指标及术后并发症发生率。结果与LCBDE+T管引流组比较,LTCBDE组患者胆总管直径明显降低(P<0.05),但其他术前特征方面差异无统计学意义(P>0.05)。LTCBDE组患者手术时间、术中出血量、术后住院时间、术后镇痛药使用时间明显低于LCBDE+T管引流组(P<0.05)。两组患者在术后第3天白细胞、总胆红素、谷丙转氨酶及C-反应蛋白水平、术后发热、术后胆漏、结石残留及胆道狭窄方面差异无统计学意义(P>0.05)。结论吲哚菁绿荧光导航LTCBDE安全可行;相较于LCBDE+T管引流,LTCBDE可减少手术时间及术中出血,缩短住院时间。

Objective To investigate the application of indocyanine green fluorescence navigated laparoscopic transcystic common bile duct exploration(LTCBDE).Methods A total of 62 patients with common bile duct stone,who underwent laparoscopic operation by a single medical team between Jan.2022 and Dec.2023 in Xianju People’s Hospital,were retrospectively analyzed.Of 62 patients,20 cases underwent indocyanine green fluorescence navigated LTCBDE(LTCBDE group),42 cases received laparoscopic common bile duct exploration with T-tube drainage(LCBDE+T-tube drainage group).The perioperative indicators and the incidence of postoperative complications were compared between the two groups.Results The diameter of common bile duct in LTCBDE group was significantly smaller than that in LCBDE+T-tube drainage group(P<0.05).No significant difference was observed in other preoperative indicators between the two groups(P>0.05).Compared with LCBDE+T-tube drainage group,LTCBDE group showed reduced operation time,intraoperative blood loss,postoperative hospitalization time and time of postoperative analgesia usage(P<0.05).Two groups showed comparable postoperative outcomes regarding the white blood cell counts,total bilibulin level,alaninetransaminase level,C-reactive protein level,and the incidence of postoperative fever,bile leakage,residual stones and biliary stricture on the 3rd day after surgery.Conclusion Indocyanine green fluorescence navigated LTCBDE is safe and feasible.Compared with LCBDE+T-tube drainage,LTCBDE can reduce the operation time,intraoperative blood loss and the postoperative hospitalization time.