Clinical Application Of Laparoscopic Cholecystectomy(LC) With Fluorescence Cholangiography Of Indocyanine Green(ICG) In The Difficult Cholecystectomy

[Objective]1.The deficiencies and advantages of laparoscopic cholecystectomy(LC)with fluorescence cholangiography of indocyanine green(ICG)in the difficult cholecystectomy are discussed by means of the comparison of conventional laparoscopic cholecystectomy(LC)and laparoscopic cholecystectomy(LC)with fluorescence cholangiography of indocyanine green(ICG).2.The safety,feasibility and reliability of laparoscopic cholecystectomy(LC)with fluorescence cholangiography of indocyanine green(ICG)are discussed,including whether the biliary tract injury can be prevented by it effectively and whether it is worthy of the clinical application3.The application prospect of laparoscopic cholecystectomy(LC)with fluorescence cholangiography of indocyanine green(ICG)in the operation of biliary tract is discussed.[Methods]The method of retrospective analysis is adopted,and the clinical datum of patients meeting inclusion criteria for difficult cholecystectomy in 65 cases of cholecystectomies with the causes of the gallstone and recurrent cholecystitis in The Second Affiliated Hospital of Kunming Medical University from December 1,2018 to December 1,2019 are collected.All patients had signed the informed consent and had no history of iodine allergy.65 patients are assigned randomly with 35 cases of laparoscopic cholecystectomy(LC)and 30 cases of laparoscopic cholecystectomy(LC)with fluorescence cholangiography of indocyanine green(ICG).All kinds of the preoperative,intraoperative and postoperative datum are collected to be compared between the conventional group and cholangiography group.The application effect,safety and feasibility of the laparoscopic technologies with fluorescence cholangiography in the difficult cholecystectomy are explored,including whether the anatomic structure of the bile duct and the biliary tract time can be identified effectively.Then the two groups of effects are input into SPSS21.0 software to calculate the check row of datum,which is expressed as(±s),and the counting datum are expressed as percentage(%).the check row x2 and P<0.05 are the basis of statistical significance.[Results](1)The results of feasibility research on the normal extrahepatic cholangiography are listed as follows:the cholangiography can be achieved in all 30 cases of patients,part of the cholangiography can be achieved when indocyanine green(LCG)is injected via the peripheral vein about 10 minutes later,and the extrahepatic cholangiography and cholecystography can be achieved in 16 minutes.(2)The time of cholangiography in difficult cholecystectomy is listed as follows:the structure of biliary tract is identified successfully in 30 cases of operations of extrahepatic cholangiography,the earliest cholangiography time is 4 minutes after the injection and the latest cholangiography time is 18 minutes after the injection,the average cholangiography time is 10.4minutes;the earliest cholecystography time is 8 minutes and the latest cholecystography time is 31 minutes,the average cholecystography time is 19.7minutes,the cholecystography cannot be achieved in 2 cases of patients with cholecystolithiasis on the neck.(3)The results about the effectiveness and safety for the identification of extrahepatic bile duct are listed as follows:①the time of laparoscopic cholecystectomy(LC)group is significantly longer than that of fluorescence cholangiography group(P<0.05);② in terms of the time to isolate the anatomy of biliary tract,the time of fluorescence cholangiography group is significantly shorter than that of laparoscopic cholecystectomy(LC)group(P<0.05);③the amount of bleeding in laparoscopic cholecystectomy(LC)is higher than that in fluorescence cholangiography group(P<0.05);④ there is 1 case of perivascular injury(right front hepatic artery injury)and 1 case of biliary tract injury(the right hepatic duct and the gallbladder duct flow into the common bile duct in parallel)in laparoscopic cholecystectomy(LC)group,the intraoperative injury rate is 10.00%;there is 1 case of perivascular injury(right front portal vein injury)in fluorescence cholangiography group,the intraoperative injury rate is 3%;⑤the time of operation in laparoscopic cholecystectomy(LC)group is longer than that in fluorescence cholangiography groupP<0.05);⑥ in terms of postoperative complications,there is 1 case of bile leakage in laparoscopic cholecystectomy(LC)group(the patient is discharged by means of delayed extubation for 5 days),2 cases of wound infection(followed with fat liquefaction and delayed wound closure,after discharge,recover within 2 weeks by means of daily dressing change),the occurrence rate of postoperative complications is 14..35%(5/35),there is 1 case of wound infection and no bile leakage in fluorescence cholangiography group,the occurrence rate of postoperative complications is 3.33%(1/30).There are no death cases in both groups;⑦there is no significant difference in length of stay(LOS)and all-in cost of stay between the two groups(P>0.005).[Conclusion]1.The operability for the identification of biliary tract in laparoscopic cholecystectomy(LC)with fluorescence cholangiography of indocyanine green(ICG)is great and convenient and flexible for the application.2.There are more advantages in laparoscopic cholecystectomy(LC)with fluorescence cholangiography of indocyanine green(ICG)compared with laparoscopic cholecystectomy(LC),including that the time of operation is shorter,amount of bleeding is much less,there is no significant differences in postoperative recovery,hospitalization period and all-in cost,the intraoperative structure of biliary tract can be identified effectively,the biliary tract and vascular injury can be avoided effectively and the operation time can be shortened effectively in difficult cholecystectomy.3.It is safe and feasible for laparoscopic cholecystectomy(LC)with fluorescence cholangiography of indocyanine green(ICG)in the cholecystectomy,which has preferable value for the clinical application.