Near-infrared fluorescence cholangiography with indocyanine green for biliary atresia. Real-time imaging during the Kasai procedure: a pilot study
Near-infrared fluorescence cholangiography with indocyanine green for biliary atresia. Real-time imaging during the Kasai procedure: a pilot study
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DOI：
10.1007/s00383-015-3799-4
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发表时间：
2015-12-01
影响因子：
1.8
通讯作者：
Yagi, Minoru
中科院分区：
文献类型：
--
作者：
Hirayama, Yutaka;Iinuma, Yasushi;Yagi, Minoru
肝门肠吻合术(HPE)加Kasai手术是治疗胆道闭锁(BA)的首选手术。然而，肝门纤维锥(FC)的合适水平常常是不清楚的，手术有时会导致不成功的结果。近年来，吲哚青绿近红外荧光成像(ICG-FCG)作为一种实时胆道造影技术已经发展起来，我们将这项技术应用于5例BA患者术中PH时的胆道血流情况。术前一天静脉注射ICG作为肝功能检查，术中用近红外摄像系统观察肝脏，同时观察患者粪便，所有患者的全肝内均可见含有ICG的淤滞胆汁，呈弥漫性荧光，肝外结构未见荧光。Fc解剖后PH的ICG荧光表现分为三种类型：点状荧光1例，弥漫性弱荧光3例，弥漫性强荧光1例。在所有五名患者中，HPE后排出的粪便显示出明显的荧光点，尽管手术前获得的粪便没有显示荧光。1例弥漫性强荧光未达JF的患者在首次HPE手术后6个月接受了活体亲属肝移植。4例患者，其中3例为弥漫性弱荧光，1例为点状荧光，与周围肝表面相比荧光较弱，我们能够在HPE术中检测到胆汁排泄的存在，并利用这一新技术成功地评估了胆汁排泄的程度。此外，ICG-FCG的发现可能提供导致新的分类的信息，并可能作为预测HPE术后临床结果的指标。
Hepatoportoenterostomy (HPE) with the Kasai procedure is the treatment of choice for biliary atresia (BA) as the initial surgery. However, the appropriate level of dissection level of the fibrous cone (FC) of the porta hepatis (PH) is frequently unclear, and the procedure sometimes results in unsuccessful outcomes. Recently, indocyanine green near-infrared fluorescence imaging (ICG-FCG) has been developed as a form of real-time cholangiography.We applied this technique in five patients with BA to visualize the biliary flow at the PH intraoperatively. ICG was injected intravenously the day before surgery as the liver function test, and the liver was observed with a near-infrared camera system during the operation while the patient's feces was also observed.In all patients, the whole liver fluoresced diffusely with ICG-containing stagnant bile, whereas no extrahepatic structures fluoresced. The findings of the ICG fluorescence pattern of the PH after dissection of the FC were classified into three types: spotty fluorescence, one patient; diffuse weak fluorescence, three patients; and diffuse strong fluorescence, one patient. In all five patients, the feces evacuated after HPE showed distinct fluorescent spots, although that obtained before surgery showed no fluorescence. One patient with diffuse strong fluorescence who did not achieve JF underwent living related liver transplantation six months after the initial HPE procedure. Four patients, including three cases involving diffuse weak fluorescence and one case involving spotty fluorescence showed weak fluorescence compared to that of the surrounding liver surface.We were able to detect the presence of bile excretion at the time of HPE intraoperatively and successfully evaluated the extent of bile excretion using this new technique. Furthermore, the ICG-FCG findings may provide information leading to a new classification and potentially function as an indicator predicting the clinical outcomes after HPE.