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

Abstract

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

CLC Number:

R657.4

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.

Figures/Tables 5

Tab. 1

Tab.2

Tab. 3

Tab. 4

Tab.5

References 24

1	XU C， YIN M， WANG H，et al. Indocyanine green fluorescent cholangiography improves the clinical effects of difficult laparoscopic cholecystectomy［J］. Surg Endosc， 2023，37（8）：5836-5846. doi:10.1007/s00464-023-10035-8 doi: 10.1007/s00464-023-10035-8
2	VU V Q， LE V T， NGUYEN H N A，et al. Preliminary results of laparoscopic cholecystectomy using real-time indocyanine green fluorescence： a cross-sectional study［J］. Ann Med Surg （Lond），2023，85（3）：402-406. doi:10.1097/ms9.0000000000000261 doi: 10.1097/ms9.0000000000000261
3	PATANKAR R， MISHRA R K， BINDAL V，et al. Efficacy of near-infrared fluorescence cholangiography using indocyanine green in laparoscopic cholecystectomy： A retrospective study［J］. J Minim Access Surg， 2023，19（1）：57-61. doi:10.4103/jmas.jmas_369_21 doi: 10.4103/jmas.jmas_369_21
4	陈志，吴宏匀，朱国栋，等. 经胆囊注射吲哚菁绿在腹腔镜困难型胆囊切除术中的应用［J］. 肝胆胰外科杂志， 2023，35（9）：530-535.
5	冯其柱，王思雨，张超. 吲哚菁绿荧光显影在困难胆囊腹腔镜胆囊切除术中的应用价值［J］. 临床肝胆病杂志， 2022，38（11）：2537-2541.
6	NI Z P， ZHANG X H， LIU Y S. Discussion on the application value of indocyanine green fluorescence staining in laparoscopic cholecystec-tomy［J］. J Abdom Surg， 2020，33（3）：212-217.
7	CASSINOTTI E， BONI L， BALDARI L. Application of indocyanine green （ICG）-guided surgery in clinical practice： lesson to learn from other organs-an overview on clinical applications and future perspectives［J］. Updates Surg， 2023，75（2）：357-365. doi:10.1007/s13304-022-01361-y doi: 10.1007/s13304-022-01361-y
8	HORISBERGER K， ROSSLER F， OBERKOFLER C E，et al. The value of intraoperative dynamic liver function test ICG in predicting postoperative complications in patients undergoing staged hepatectomy： a pilot study［J］. Langenbecks Arch Surg， 2023，408（1）：264. doi:10.1007/s00423-023-02983-5 doi: 10.1007/s00423-023-02983-5
9	ZHANG P， LUO H， ZHU W，et al. Real-time navigation for laparoscopic hepatectomy using image fusion of preoperative 3D surgical plan and intraoperative indocyanine green fluorescence imaging［J］. Surg Endosc， 2020，34（8）：3449-3459. doi:10.1007/s00464-019-07121-1 doi: 10.1007/s00464-019-07121-1
10	POTHARAZU A V， GANGEMI A. Indocyanine green （ICG） fluorescence in robotic hepatobiliary surgery： A systematic review［J］.Int J Med Robot， 2023，19（1）：e2485. doi:10.1002/rcs.2485 doi: 10.1002/rcs.2485
11	HUANG C C， HSIEH C H， SIOW T F，et al. Indocyanine green staining via hyperselective portal vein angiographic approach for laparoscopic S8 anatomical subsegmentectomy［J］. Asian J Surg，2023，46（7）：2802-2803. doi:10.1016/j.asjsur.2023.01.053 doi: 10.1016/j.asjsur.2023.01.053
12	焦伟，赵凯，汪正，等. 吲哚菁绿近红外荧光成像技术在乳腺癌保乳手术中的应用［J］. 实用医学杂志， 2023，39（11）：1444-1450. doi:10.3969/j.issn.1006-5725.2023.11.021 doi: 10.3969/j.issn.1006-5725.2023.11.021
13	LIM S H， TAN H T A， SHELAT V G. Comparison of indocyanine green dye fluorescent cholangiography with intra-operative cholangiography in laparoscopic cholecystectomy： a meta-analysis［J］. Surg Endosc， 2021，35（4）：1511-1520. doi:10.1007/s00464-020-08164-5 doi: 10.1007/s00464-020-08164-5
14	BANDARI M， PAI M V， ACHARYA A，et al. Anatomical mapping of the biliary tree during laparoscopic cholecystectomy by using indocyanine green dye［J］. J Minim Access Surg， 2022，18（2）：218-223. doi:10.4103/jmas.jmas_87_21 doi: 10.4103/jmas.jmas_87_21
15	STOLZ M P， FOXHALL E N， GIBSON B H，et al. Improving the Safety of Laparoscopic Cholecystectomy with Indocyanine Green Dye Using Critical View of Safety Plus［J］. Am Surg， 2023，89（7）：3136-3139. doi:10.1177/00031348231161659 doi: 10.1177/00031348231161659
16	D'ACAPITO F， CUCCHETTI A， SOLAINI L，et al. Fluorescence Cholangiography Using Indocyanine Green Improves the Identification of Biliary Structures During Laparoscopic Cholecystectomy［J］. World J Surg， 2023，47（3）：666-673. doi:10.1007/s00268-022-06854-w doi: 10.1007/s00268-022-06854-w
17	PARDO A F， GENE S C， LOPEZ-SANCHEZ J，et al. Indocyanine green （ICG） fluorescent cholangiography in laparoscopic cholecystectomy： Simplifying time and dose［J］. Dig Liver Dis， 2023，55（2）：249-253. doi:10.1016/j.dld.2022.10.023 doi: 10.1016/j.dld.2022.10.023
18	DIP F， ALEMAN J， DEBOER E，et al. Use of fluorescence imaging and indocyanine green during laparoscopic cholecystectomy： Results of an international Delphi survey［J］. Surgery， 2022，172（6S）：S21-S28. doi:10.1016/j.surg.2022.07.012 doi: 10.1016/j.surg.2022.07.012
19	BADAWY A， EL-SAYES I A， SABRA T. Image-guided laparoscopic cholecystectomy using indocyanine green fluorescence cholangiography： what is the optimal time of administration？［J］. Minim Invasive Ther Allied Technol， 2022，31（6）：872-878. doi:10.1080/13645706.2022.2026974 doi: 10.1080/13645706.2022.2026974
20	HUANG Y， CHEN Q， KUANG J，et al. Real-time fluorescent cholangiography with indocyanine green in laparoscopic cholecystectomy： a randomized controlled trial to establish the optimal indocyanine green dose within 30 min preoperatively［J］. Surg Today，2023，53（2）：223-231. doi:10.1007/s00595-022-02563-y doi: 10.1007/s00595-022-02563-y
21	PATANKAR R， MISHRA R K， BINDAL V，et al. Efficacy of near-infrared fluorescence cholangiography using indocyanine green in laparoscopic cholecystectomy： A retrospective study［J］. J Minim Access Surg， 2023，19（1）：57-61. doi:10.4103/jmas.jmas_369_21 doi: 10.4103/jmas.jmas_369_21
22	CASTAGNETO-GISSEY L， RUSSO M F， IODICE A，et al.Intracholecystic versus Intravenous Indocyanine Green （ICG） Injection for Biliary Anatomy Evaluation by Fluorescent Cholangiography during Laparoscopic Cholecystectomy： A Case-Control Study［J］. J Clin Med， 2022，11（12）：3508. doi:10.3390/jcm11123508 doi: 10.3390/jcm11123508
23	符庆胜，周永振，李涛，等. 经胆囊注射吲哚菁绿在症状性胆囊结石合并肝硬化手术中的疗效评价［J］. 国际外科学杂志，2022，49（8）：532-538，F3. doi:10.3760/cma.j.cn115396-20220716-00234 doi: 10.3760/cma.j.cn115396-20220716-00234
24	SHIBATA H， AOKI T， KOIZUMI T，et al. The Efficacy of Intraoperative Fluorescent Imaging Using Indocyanine Green for Cholangiography During Cholecystectomy and Hepatectomy［J］. Clin Exp Gastroenterol， 2021，14：145-154. doi:10.2147/ceg.s275985 doi: 10.2147/ceg.s275985

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

Comparison of the effect of indocyanine green injection through peripheral vein and gallbladder in laparoscopic cholecystectomy of difficult gallbladder

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 5

References 24

Related Articles 15

Recommended Articles

Metrics

Comments

[1]	Kaiyu LI,Minyu TANG,Peng. LIANG. The effect of target controlled infusion of sufentanil or remifentanil on postoperative pain relief and recovery in patients undergoing daytime laparoscopic cholecystectomy [J]. The Journal of Practical Medicine, 2024, 40(8): 1074-1077.
[2]	Xiaotong LIU,Xianhua SU,Zhijun XIN,Fengqiong GAO,Jiayi FENG,Tongxia. XIA. Risk factors of postoperative complications in patients with spinal tuberculosis and the predictive value of prognostic nutritional index [J]. The Journal of Practical Medicine, 2024, 40(7): 972-978.
[3]	Kaiqiang WANG,Zhi CAO,Wei WANG,Chenglin YANG,Yue YANG,Huifen ZHANG,Xaioming ZHANG. Effects of Diosmine on semen quality and sex hormone concentration in patients with spermatovenous ligation [J]. The Journal of Practical Medicine, 2024, 40(3): 389-393.
[4]	Xing LI,Youcai WANG,Yongchao XU,Ligong TANG,Fangyuan. CHENG. Application of prophylactic ileostomy through right lower abdominal specimen extraction incision in laparoscopic rectal low anterior resection [J]. The Journal of Practical Medicine, 2024, 40(19): 2720-2725.
[5]	Liwei LIU,Erliang KONG,Yuheng LI,Mingyue LI,Weina LIU,Xudong. FENG. Effect of esketamine versus sufentanil on postoperative pain after anesthesia induction in obese patients undergoing laparoscopic sleeve gastrectomy [J]. The Journal of Practical Medicine, 2024, 40(17): 2454-2459.
[6]	Meixiao FAN,Minjuan ZHANG,Shasha PANG,Shan HE,Zhihong LU,Dong. XING. Effect of neuromuscular blockade protocol on postoperative shoulder pain in patients undergoing robot⁃assisted laparoscopic surgery： A single⁃center randomized controlled clinical trial [J]. The Journal of Practical Medicine, 2024, 40(17): 2460-2464.
[7]	Na LI,Zhenhua WANG,Qianqian NIU,Guiqin CHEN,Suiyu LUO,Li DONG. The clinical effect of Tension⁃free laparoscopic lateral suspension with mesh for pelvic organ prolapse [J]. The Journal of Practical Medicine, 2024, 40(12): 1683-1689.
[8]	WANG Haijin, WANG Kegong, GONG Ting, LIU Ying, ZHANG Zhen, LUO Huiyu. . Application of laparoscopic guided regional nerve block of bilateral uterosacral ligaments in gynecological endoscopic myomectomy [J]. The Journal of Practical Medicine, 2023, 39(9): 1127-1131.
[9]	WANG Yuanyuan, LIU Wenjuan, HUANG Li, RUAN Jianxing, WENG Huinan, LIU Fenghua.. Degree of benefit from laparoscopic surgery before in vitro fertilization and embryo transfer in infertile patients with tubal obstruction [J]. The Journal of Practical Medicine, 2023, 39(4): 442-446.
[10]	Ying GAN,Bao WANG,Jiayin YAO,Xinhua YAO,Dong LIU,Rong HUANG,Yi. LU. Analgesic effect of perioperative electroacupuncture stimulation on laparoscopic surgery [J]. The Journal of Practical Medicine, 2023, 39(20): 2612-2617.
[11]	GUO Kedi, WU Yan, TANG Xihui, PEI Yuping. . Influence of preoperative frailty on postoperative complications in elderly patients after lung cancer sur⁃ gery [J]. The Journal of Practical Medicine, 2023, 39(15): 1956-1960.
[12]	XIN Chao, GAO Ju, GE Yali, WU Keting, CHEN Xiaoping. . Effect of driving pressure ⁃directed individualized end ⁃breath positive pressure ventilation on cerebral hemodynamics and regional cerebral oxygen saturation in elderly patients undergoing robot⁃assisted lapa⁃ roscopic radical prostatectomy [J]. The Journal of Practical Medicine, 2023, 39(12): 1524-1528.
[13]	JIAO Wei, ZHAO Kai, WANG Zheng, CHEN Bin, WANG Yabing.. Application of indocyanine green near ⁃ infrared fluorescence imaging in breast conserving surgery for breast cancer [J]. The Journal of Practical Medicine, 2023, 39(11): 1444-1450.
[14]	WU Ahao, SHU Xufeng, CAO Yi, TAN Yu′ao, HUANG Pan, LI Zhengrong.. Median specimen extraction incision vs. the traditional right lower abdominal incision for prophylactic ileostomy in radical resection of rectal cancer：A comparative perspective [J]. The Journal of Practical Medicine, 2022, 38(8): 985-990.
[15]	TAN Yu′ao, LI Zhengrong, WU A′hao, ZENG Qingwen.. Comparison of short⁃term efficacy between robotic and laparoscopic radical gastrectomy for gastric cancer patients with different body mass index [J]. The Journal of Practical Medicine, 2022, 38(22): 2801-2812.