经外周静脉和胆囊注射吲哚菁绿在腹腔镜困难胆囊切除术中应用效果对比

doi:10.3969/j.issn.1006-5725.2024.11.012

摘要/Abstract

摘要：

目的比较经外周静脉和胆囊注射吲哚菁绿（ICG）在腹腔镜困难胆囊切除术（LC）中的应用效果。方法将安徽理工大学第一附属医院肝胆外科2023年5~10月间由同一手术团队行LC的困难胆囊患者按随机数字表分为3组，A组术前经外周静脉静推ICG，B组术中经胆囊注射ICG，C组为对照组。比较3组患者手术时间、术中出血量、住院时间、住院费用和术后并发症间的差异，以及A组和B组荧光模式肝外胆管显影效果。正态分布的计量资料组间比较采用单因素方差分析，用LSD-t检验进行两两比较；计数资料数据比较用χ ² 检验，用Boferroni法检验进行两两比较。结果三组住院时间、住院费用和术后并发症间相比差异无统计学意义（均P > 0.05）；A组和B组的手术时间和术中出血量低于C组（均P < 0.05），而A组和B组间相比差异无统计学意义（均P > 0.05）。A组游离胆囊三角前（早期）三管总显像率为41.67%，低于B组的63.89%（P < 0.05）。结论 ICG有利于困难胆囊LC术中识别肝外胆管结构，而经胆囊注射ICG对早期识别肝外胆管有帮助。

关键词: 胆囊切除术, 腹腔镜, 吲哚花青绿, 胆管, 手术后并发症

Abstract:

Objective The aim of this study was to compare the effect of injection of indocyanine green （ICG） through peripheral vein and gallbladder in laparoscopic cholecystectomy （LC） of difficult gallbladder. Methods Patients with difficult gallbladder who underwent LC by the same surgical team from May to October 2023 in the Department of Hepatobiliary Surgery， the First Affiliated Hospital of Anhui University of Science and Technology were divided into three groups according to A random number table. Group A was injected ICG through peripheral vein before operation， group B was injected ICG through gallbladder during operation， and group C was the control group. The differences of operation time， intraoperative blood loss， hospitalization time， hospitalization cost and postoperative complications among the three groups were compared， and the effects of fluorescence mode cholangiogram in group A and group B were compared. One-way analysis of variance was used to compare the normal distribution of the measurement data among groups， and LSD-t test was used to compare the two groups. The counting data was compared by chi-square test. The Boferroni test was appied to compare the two groups. Results There were no differences in length of stay， hospitalization cost and postoperative complications among the three groups （P > 0.05）. The operative time and intraoperative blood loss of group A and group B were lower than those of group C （P < 0.05）， but there was no difference between group A and group B （P > 0.05）. The total imaging rate of the first three tubes of free gallbladder triangle（early stage） in group A was 41.67%， which was significantly lower than that in group B （63.89%）（P < 0.05）. Conclusion ICG is beneficial for the identification of extrahepatic bile duct structures during LC of difficult gallbladder， and ICG injection through the gallbladder is helpful for the early identification of extrahepatic bile duct.

Key words: cholecystectomy, laparoscopic, indocyanine green, bile ducts, postoperative complications

中图分类号:

R657.4

冯其柱,徐喆,孙杰,张家泉,丁升,张健,王琦,张超. 经外周静脉和胆囊注射吲哚菁绿在腹腔镜困难胆囊切除术中应用效果对比[J]. 实用医学杂志, 2024, 40(11): 1537-1541.

Qizhu FENG,Zhe XU,Jie SUN,Jiaquan ZHANG,Sheng DING,Jian ZHANG,Qi WANG,Chao. ZHANG. Comparison of the effect of indocyanine green injection through peripheral vein and gallbladder in laparoscopic cholecystectomy of difficult gallbladder[J]. The Journal of Practical Medicine, 2024, 40(11): 1537-1541.

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组别	例数	性别（例）		年龄（岁）	合并症（例）	上腹部手术史（例）	BMI（kg/m²）	ALT（U/L）	AST（U/L）
组别	例数	男	女	年龄（岁）	合并症（例）	上腹部手术史（例）	BMI（kg/m²）	ALT（U/L）	AST（U/L）
A组	60	18	42	53.07 ± 15.07	39	3	23.45 ± 3.31	35.83 ± 15.36	43.08 ± 16.19
B组	60	11	49	53.33 ± 12.84	30	4	22.83 ± 3.18	38.20 ± 11.46	39.07 ± 15.11
C组	60	18	42	50.97 ± 14.35	40	2	24.02 ± 2.76	39.22 ± 13.44	38.88 ± 14.13
F/χ ² 值		2.822		0.506	4.233	0.702	0.854	0.990	1.470
P值		0.244		0.604	0.120	0.704	0.578	0.374	0.233

组别	例数	慢性胆囊炎急性发作	急性胆囊炎	胆囊管结石	PTGBD	胆囊萎缩
A组	60	36	17	4	2	1
B组	60	41	14	2	2	1
C组	60	39	12	6	1	2
χ²值		0.921	1.677	2.143	0.411	0.511
P值		0.631	0.432	0.343	0.814	0.774

组别	手术时间（min）	住院时间（d）	术中出血（mL）	住院费用（元）	三孔法四孔法比（例）
A组（n = 60）	67.80 ± 19.35	6.60 ± 2.09	10.25 ± 4.71	12 303.27 ± 1 637.92	43/17
B组（n = 60）	68.88 ± 19.00	7.35 ± 3.03	9.68 ± 4.54	12 405.60 ± 1 582.63	49/11
C组（n = 60）	79.57 ± 25.47	7.36 ± 3.29	21.87 ± 8.42	1 261.31 ± 2 409.12	30/30
F/χ ² 值	5.500	1.414	24.913	0.557	14.398
P值	0.005	0.246	0.001	0.574	0.001

组别	胆囊管显影率（%）	胆总管显影率（%）	肝总管显影率（%）	三管总显影率（%）
A组（n = 60）	36.67（22/60）	58.33（35/60）	33.33（18/60）	41.67（75/180）
B组（n = 60）	66.67（40/60）	70.00（42/60）	50.00（33/60）	63.89（115/180）
χ²值	10.812	1.776	7.673	17.833
P值	0.001	0.183	0.006	0.000

组别	胆囊管显影率（%）	胆总管显影率（%）	肝总管显影率（%）	三管总显影率（%）
A组（n = 60）	91.67（55/60）	93.33（56/60）	86.67（52/60）	90.56（163/180）
B组（n = 60）	95.00（57/60）	95.00（57/60）	95.00（57/60）	95.00（171/180）
χ²值	0.536	0.152	2.502	2.653
P值	0.464	0.697	0.114	0.103