王锦祥 郑俊城 洪旭雯 刘特彬 李晓辉

【摘要】 目的：探讨吲哚菁绿（ICG）荧光影像引导在复杂肝胆道结石手术中胆道识别的临床应用。方法：选取2021年1-9月本科收治的行再次胆道探查取石的复杂肝胆道结石手术患者120例作为研究对象，按随机数字表法分为对照组和观察组，每组60例。对照组采取常规腹腔镜肝外胆管探查术，观察组在对照组的基础上术中采取ICG荧光融合影像引导。记录并比较两组术中术后情况。结果：观察组手术时间、寻找胆总管时间均短于对照组，术中出血量少于对照组，差异均有统计学意义（P<0.05）;观察组胆总管损伤率为0，低于对照组的10.00%（P<0.05）;观察组其他并发症发生率为3.33%，明显低于对照組的15.00%（P<0.05）。观察组排气时间、住院时间均短于对照组（P<0.05）。结论：吲哚菁绿荧光影像引导可实时显示肝胆道系统，有效缩短手术时间，避免胆道损伤，减少并发症的发生。

【关键词】 吲哚菁绿荧光影像 肝胆道结石 胆道探查 胆道识别

Clinical Application of Indocyanine Green Fluorescence Imaging Guidance in Biliary Tract Recognition in Complex Hepatolithiasis Surgery/WANG Jinxiang， ZHENG Juncheng， HONG Xuwen， LIU Tebin， LI Xiaohui. //Medical Innovation of China， 2021， 18（35）： -126

[Abstract] Objective： To explore the clinical application of indocyanine green （ICG） fluorescence imaging guidance in biliary tract recognition in complex hepatolithiasis surgery. Method： A total of 120 patients with complex hepatobiliary tract stone surgery admitted to our department from January to September 2021 who underwent biliary tract exploration and stone removal were selected as the research objects， according to the random number table， they were divided into the control group and the observation group， 60 cases in each group. The control group was given conventional laparoscopic extrahepatic bile duct exploration， and the observation group was guided by ICG fluorescence fusion imaging during the operation on the basis of the control group. The intraoperative and postoperative conditions of two groups were recorded and compared. Result： The operation time， common bile duct search time of the observation group were shorter than those of the control group， the intraoperative blood loss was less than that of the control group， the differences were statistically significant （P<0.05）. The bile duct damage rate of the observation group was 0， which was lower than 10.00% of the control group （P<0.05）; the total incidence of other complications of the observation group was 3.33%， which was significantly lower than 15.00% of the control group （P<0.05）. The exhaust time and hospitalization time of the observation group were shorter than those of the control group （P<0.05）. Conclusion： ICG fluorescence imaging guidance can display the hepatobiliary system in real time， effectively shorten the operation time， avoid bile duct damage， and reduce the occurrence of complications.

[Key words] Indocyanine green fluorescence imaging Hepatolithiasis Biliary tract exploration Biliary tract recognition

First-authors address： Puning Peoples Hospital， Puning 515300， China

doi：10.3969/j.issn.1674-4985.2021.35.030

肝胆道结石即位于肝内外胆管中的结石，多见于亚洲东、南部国家，常见于我国局部地区，具有病情复杂、发病率高、复发率高等特点[1]。该疾病临床上以手术治疗为主，但由于胆管在机体内位置特殊，术后残石率、并发症发生率均较高，通常需要再次手术取石[2]。复杂肝胆道结石手术指有过一次以上的肝胆道结石手术或其他腹部手术病史导致术中出现胆总管识别困难，延长寻找胆总管时间，进而增加手术难度[3]。吲哚菁绿是一种近红外荧光染料，吲哚菁绿荧光影像作为一项新技术開始应用于肝胆外科手术[4]。田广金等[5]研究表明吲哚菁绿荧光影像引导腹腔镜再次胆道探查术可实时可视化肝胆道，安全性高。本研究旨在探讨吲哚菁绿荧光影像引导在复杂肝胆道结石手术中胆道识别的临床应用，为临床提供依据。……