胆道引流术后荧光腹腔镜手术治疗胆囊结石的临床疗效

Clinical efficacy of fluorescence-navigated laparoscopic surgery in treatment of cholecystolithiasis after biliary drainage

摘要:

背景与目的 腹腔镜胆囊切除术（LC）中经胆道直接注射吲哚菁绿（ICG）行荧光胆管显影，有即刻显影及零肝脏背景荧光的优势，在复杂LC中有更好的效果。本研究旨在探讨经皮经肝胆囊穿刺引流术（PTGBD）或经内镜鼻胆管引流术（ENBD）术后行荧光LC的临床效果。方法 选取2019年1月—2021年4月120例行LC的胆囊结石患者的临床资料，在经PTGBD或ENBD术后60例行注射ICG荧光导航的LC（观察组），60例行普通白光LC（对照组）。比较两组患者的肝外胆管显示率及相关临床指标。结果 两组患者的术前一般资料差异无统计学意义（均P>0.05）。解剖胆囊三角前，观察组的肝总管、胆总管、胆囊管、胆囊管胆总管汇合部及胆囊颈部显示率明显高于对照组（均P<0.05），但两组的右肝管显示率差异无统计学意义（P>0.05）；解剖胆囊三角后，观察组的肝总管、胆总管及胆囊管胆总管汇合部显示率明显高于对照组（均P<0.05）。与对照组比较，观察组患者手术用时缩短、术中出血量减少，肝下引流管放置率降低，术后住院时间缩短（均P<0.05）。两组的住院费用、并发症发生率差异无统计学意义（均P>0.05）。结论 荧光导航LC的运用有利于提高肝外胆管的显示率，降低PTGBD及ENBD术后复杂LC的难度，缩短手术时间及住院时间，减少术中出血量及肝下引流管留置。

Abstract:

Background and Aims Fluorescence cholangiography by intrabiliary indocyanine green (ICG) injection during laparoscopic cholecystectomy (LC) has the advantage of immediate display with zero background liver fluorescence. It is more suitable for complex LC. This study was conducted to investigate the efficacy of fluorescent LC after percutaneous transhepatic gallbladder drainage (PTGBD) or endoscopic nasobiliary drainage (ENBD).Methods The clinical data of 120 patients with gallbladder stones undergoing LC from January 2019 to April 2021 were selected. Of the patients, 60 cases underwent fluorescence-navigated LC by injection of ICG through the PTGBD tube or ENBD tube (observation group), and 60 cases underwent conventional LC (control group). The display rates of the extrahepatic bile duct structures and the main clinical variables were compared between the two groups.Results The preoperative general data showed no significant difference between the two groups of patients (all P>0.05). Before dissection of the Calot's triangle, the display rates of the common hepatic duct, the common bile duct, the cystic duct, the junction of cystic duct and common bile duct and the neck of the gallbladder were significantly higher in observation group than those in control group (all P<0.05), but there was no significant difference in display rate of the right hepatic duct between the two groups (P>0.05); After dissection of the Calot's triangle, the display rates of the common hepatic duct, the common bile duct and the junction of cystic duct and common bile duct were significantly higher in observation group than those in control group (all P<0.05). In observation group compared with control group, the operative time, the intraoperative blood loss, the rate of subhepatic drainage tube placement, and length of postoperative hospital stay were all significantly reduced (all P<0.05). There was no significant difference in hospitalization cost and incidence rate of postoperative complications between the two groups (all P>0.05).Conclusions The application of fluorescence-navigated LC is beneficial to improve the display rate of the extrahepatic bile duct structures, decrease the degree of difficulty of complex LC after PTGBD and ENBD, shorten the operative time and postoperative hospital stay, and reduce the intraoperative blood loss and subhepatic drainage tube placement.