吲哚菁绿荧光显像技术在复杂腹腔镜胆囊切除术中的临床应用

目的 探讨吲哚菁绿（indocyanine green，ICG）荧光显像技术在复杂腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）中的临床应用。方法 对2019年7月至2020年1月期间遂宁市中心医院肝胆外科收治的31例在ICG荧光显像技术辅助下完成复杂LC的患者临床资料进行回顾性分析。术前ICG皮试阴性，于术前60 min注射ICG，术中利用近红外光三维显像肝外胆管结构。在ICG显像引导下行LC。结果 31例患者均顺利完成LC手术，其中26例患者胆总管和胆囊管ICG显像；5例胆囊管未显像，但胆总管显像。手术时间41（25～89）min，术中出血量7（3～15）mL，术后住院时间3.5（2～6）d。所有患者术后恢复顺利，1例切口感染，1例剑突下伤口红肿，无胆漏等并发症发生，术后随访1～7个月无并发症发生。结论 利用ICG荧光显像技术优势，可以对肝外管道系统进行显像，辅助复杂腹腔镜胆囊切除术的顺利完成，避免医源性肝外胆管损伤，值得临床推广应用。

Clinical application of indocyanine green fluorescence imaging in complex laparoscopic cholecystectomy

Objective To investigate the application of indocyanine green (ICG) fluorescence imaging technology in complex laparoscopic cholecystectomy (LC). Methods Clinical data of 31 patients who underwent LC with the assistance of ICG fluorescence imaging technology in Suining Central Hospital from Jul. 2019 to Jan. 2020 were retrospectively analyzed. ICG skin test was conducted before operation and all 31 patients were proved to be ICG negative. ICG was then injected through the back of the hand or the median vein of the elbow 60 minutes before operation. Near-infrared light was used to visualize extrahepatic bile duct structure during the operation. LC was performed under the guidance of ICG imaging. Results LC surgery was successfully performed in all the 31 patients, of whom 26 patients had ICG imaging of both the common bile duct and gallbladder duct; and 5 cases had common bile duct imaging only, without imaging of common bile duct. The operation time was 41 min, ranging from 25 to 89 min; the intraoperative blood loss was 7 mL, ranging from 3 to 15 mL; the postoperative hospitalization time was 3.5 d, ranging from 2 to 6 d. One case had incision infection, and one case had a swollen sub-xiphoid wound. There were no complications such as bile leakage or intestinal leakage. No complications occurred during the follow-up of 1 to 7 months. Conclusion The advantages of ICG fluorescence imaging technology can be used to image extrahepatic biliary system, assist the successful completion of complex LC, and avoid iatrogenic extrahepatic bile duct injury, which is worthy of clinical promotion and application.