吲哚菁绿在腹腔镜下输尿管狭窄修复重建术中的临床应用

Clinical application of indocyanine green in laparoscopic repair and reconstruction of ureteral stricture

目的评估吲哚菁绿(indocyanine green,ICG)近红外荧光成像在腹腔镜下输尿管狭窄修复重建术中的临床应用效果。方法回顾性分析2020年1月至2023年1月湖州师范学院附属第一医院收治的36例行腹腔镜下输尿管狭窄修复重建术患者的临床资料,术中采用ICG近红外荧光成像逆行显影输尿管狭窄段分为荧光组(n=24),仅凭术者术中肉眼观察输尿管狭窄段,未采用ICG近红外光成像分为对照组(n=12)。采集入组患者年龄、性别、狭窄类型,电子计算机断层扫描(computed tomography,CT)下肾积水程度,CT下输尿管长度等基线资料,比较两组术中定位狭窄段的速度及精确性、术后肾积水改善程度。结果荧光组中22例患者成功显影输尿管狭窄位置。荧光组术中对狭窄段的定位速度较对照组更快(P<0.01),且保留正常输尿管更多(P<0.05)。术后随访3、6、12个月时,荧光组明显改善肾积水程度,其影像学最大横径低于对照组(P值分别为0.017、0.032、0.004)。结论ICG近红外荧光成像技术可精准定位输尿管狭窄,提升手术治疗效果。

Objective To assess the clinical application efficacy of indocyanine green(ICG)near-infrared fluorescence imaging in laparoscopic repair and reconstruction of ureteric stricture.Methods A retrospective analysis was conducted on 36 patients diagnosed with ureteral stricture and undergoing laparoscopic repair and reconstruction of ureteric stricture at The First Affiliated Hospital of Huzhou Normal College from January 2020 to January 2023,and the patients were divided into the fluorescent group(24 cases)and control group(12 cases).The patients in the fluorescent group used intraoperative ICG near-infrared fluorescence imaging to retrogradely visualize the ureteral stenosis segment,while the patients in the control group only relied on the naked eye observation during the operation,without using ICG nearinfrared light imaging.Baseline data including age,gender,type of stricture,degree of hydronephrosis assessed by computed tomography(CT),and length of the ureter measured by CT were collected for all enrolled patients.The speed and accuracy of intraoperative localization of the strictured segment and the postoperative improvement of hydronephrosis were compared between the two groups.Results Successful localization of ureteral strictures was achieved in 22 patients in the fluorescence group.Compared to the control group,the fluorescence group exhibited a significantly faster intraoperative localization speed for strictured segments(P<0.01),along with a higher rate of preserved normal ureters(P<0.05).During follow-up periods at 3 months,6 months,and 12 months after surgery,significant improvements in hydronephrosis were observed in the fluorescence group compared to the control group,and maximum transverse diameter on imaging was lower than that in controls(P=0.017,P=0.032,P=0.004).Conclusion ICG near-infrared fluorescence imaging technology enables accurate localization of ureteral strictures and enhances surgical treatment efficacy.