Techniques of Fluorescence Cholangiography During Laparoscopic Cholecystectomy for Better Delineation of the Bile Duct Anatomy.
Techniques of Fluorescence Cholangiography During Laparoscopic Cholecystectomy for Better Delineation of the Bile Duct Anatomy.
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DOI：
10.1097/md.0000000000001005
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发表时间：
2015-06
期刊：
影响因子：
1.6
通讯作者：
Kokudo N
中科院分区：
文献类型：
--
作者：
Kono Y;Ishizawa T;Tani K;Harada N;Kaneko J;Saiura A;Bandai Y;Kokudo N
评估影响荧光胆管造影（FC）在腹腔镜胆囊切除术（LC）中使用吲哚菁绿（ICG）描绘胆管解剖结构能力的临床和技术因素。在腹腔镜荧光成像系统商业化后，FC在LC中的应用开始了。108例行LC的患者在术前切开Calot三角区时静脉注射ICG （2.5 mg）进行FC，评估影响FC描绘肝外胆管能力的临床因素。在离体研究中，还评估了5种腹腔镜系统和1种开放式荧光成像系统中与胆管可检测性相关的设备相关因素。FC分别描绘了80例（74%）患者和99例（92%）患者在Calot三角区剥离前后的胆囊管和肝总管（CyD-CHD）汇合处。分离前荧光成像检测到cyd -冠心病合流的80例患者（中位数，90 min，范围，15 ~ 165 min）注射ICG和FC的间隔时间明显长于未检测到cyd -冠心病合流的28例患者（中位数，47 min，范围，21 ~ 205 min, P < 0.01）。不同腹腔镜成像系统对胆管标本荧光图像的信号对比度有明显差异，且随着靶-腹腔镜距离的增加和覆盖标本的猪组织厚度的增加，荧光图像的信号对比度有比开放式成像系统更急剧下降的趋势。FC是一种简单的导航工具，用于在LC期间获得胆道路线图以达到“安全关键视图”。FC更好地识别胆管的关键因素是术前尽可能提前给予ICG，胆管周围结缔组织充分延伸，腹腔镜尖端靠近并垂直于Calot三角。
Supplemental Digital Content is available in the text To evaluate the clinical and technical factors affecting the ability of fluorescence cholangiography (FC) using indocyanine green (ICG) to delineate the bile duct anatomy during laparoscopic cholecystectomy (LC). Application of FC during LC began after laparoscopic fluorescence imaging systems became commercially available. In 108 patients undergoing LC, FC was performed by preoperative intravenous injection of ICG (2.5 mg) during dissection of Calot's triangle, and clinical factors affecting the ability of FC to delineate the extrahepatic bile ducts were evaluated. Equipment-related factors associated with bile duct detectability were also assessed among 5 laparoscopic systems and 1 open fluorescence imaging system in ex vivo studies. FC delineated the confluence between the cystic duct and common hepatic duct (CyD–CHD) before and after dissection of Calot's triangle in 80 patients (74%) and 99 patients (92%), respectively. The interval between ICG injection and FC before dissection of Calot's triangle was significantly longer in the 80 patients in whom the CyD–CHD confluence was detected by fluorescence imaging before dissection (median, 90 min; range, 15–165 min) than in the remaining 28 patients in whom the confluence was undetectable (median, 47 min; range, 21–205 min; P < 0.01). The signal contrast on the fluorescence images of the bile duct samples was significantly different among the laparoscopic imaging systems and tended to decrease more steeply than those of the open imaging system as the target-laparoscope distance increased and porcine tissues covering the samples became thicker. FC is a simple navigation tool for obtaining a biliary roadmap to reach the “critical view of safety” during LC. Key factors for better bile duct identification by FC are administration of ICG as far in advance as possible before surgery, sufficient extension of connective tissues around the bile ducts, and placement of the tip of laparoscope close and vertically to Calot's triangle.