| Objectives To investigate the value of indocyanine green(ICG)fluorescence imaging and conventional laparoscopy in laparoscopic cholecystectomy(LC)+laparoscopic common bile duct exploration(LCBDE).Methods Collect the case data of 106 patients with LC+LCBDE who met the standards in the Department of Hepatobiliary,Pancreatic,and Splenic Surgery of Hebei General Hospital from January 2019 to December 2020.39 patients with LC+LCBDE under ICG guidance,there are 67 patients under ordinary LC+LCBDE.According to the patient’s medical history,intraoperative conditions,etc.,the patients were divided into group A(difficult type ICG+LC+LCBDE,n=16),group B(common ICG+LC+LCBDE,n=23),and group C(difficult type LC+LCBDE,n=22),group D(common LC+LCBDE,n=45).Collect the patient’s gender,age,BMI,gallbladder wall thicknesscommon bile duct width,gallbladder wall thickness,history of abdominal surgery,ERCP history,smoking history,underlying disease,preoperative ASA classification,bile duct exposure before and after the anatomy of the gallbladder triangle,operation duration,blood loss,Relevant data such as the conversion to laparotomy,length of hospitalization,hospitalization expenses,postoperative complications,etc.Use SPSS statistical software for statistical analysis,compare the relevant clinical data between groups A and C,and between groups B and D,and evaluate the actual application of ICG fluorescence imaging technology in LC+LCBDE.The correlation analysis of intraoperative biliary tract exposure and clinical data was analyzed byχ~2 test to obtain statistically significant single-factor data.Logistic regression multi-factor analysis was performed according to the results of single factor analysis of variance related to clinical data to obtain the independent influencing factors of intraoperative biliary tract development.Results The 106 patients included all completed the LC+LCBDE operation and were discharged from the hospital.39 patients succeeded in ICG fluorescence imaging,and 10patients were converted to laparotomy.There was no statistically significant difference in the preoperative general data of groups A and C:age,gender,BMI,gallbladder wall thickness,common bile duct width,abdominal surgery history,ERCP history,smoking history,underlying disease status(P>0.05);The difference in ASA classification was statistically significant(P<0.05).Intraoperative general data comparison:there was no statistically significant difference in the biliary tract imaging rate between the A and C groups before the gallbladder triangle dissected(P>0.05);In the case of complete exposure of the biliary tract after the dissection of the gallbladder triangle(CD+CBD),group A was significantly better than group C(P<0.05);In terms of intraoperative blood loss,there was no statistical difference between group A and group C(P>0.05);The operation time of group A was shorter than that of group C and the difference was statistically significant(P<0.05);In group A,one patient was converted to laparotomy,and four patients in group C were converted to laparotomy,there was no significant difference between the groups(P>0.05).General postoperative data of groups A and C:group A was significantly better than group C in hospitalization expenses and hospital stay.The difference between the two groups was statistically significant(P<0.05).In terms of postoperative complications in groups A and C:the differences in total complications and electrolyte disturbances between groups A and C were statistically significant(P<0.05),and there was no significant difference in other indicators(P>0.05).In terms of general preoperative data in groups B and D:there was no statistically significant difference in general data before surgery(P>0.05);Comparison of general data in groups B and D:comparison of general data in groups B and D before and after the anatomy of the gallbladder triangle There was no statistically significant difference in exposure and operation time(P>0.05);The difference in intraoperative blood loss between groups B and D was statistically significant(P<0.05),group B had more intraoperative blood loss than group D;There was no statistically significant difference in the number of conversion to laparotomy in the group B and D(P>0.05);General postoperative data of groups B and D:there was no significant difference in hospitalization expenses and length of stay between group B and group D(P>0.05);Group B comparison of postoperative complications with group D:There was no significant difference in postoperative complications between groups B and D(P>0.05).The results of univariate analysis showed that age and ASA grade were related factors for complete exposure of the biliary tract(P<0.05),and there was no statistical difference in the distribution of other variables between groups(P>0.05);The results of multivariate logistic regression analysis showed that:age and ASA Grading is not a relevant factor for the complete exposure of the biliary tract(P>0.05).Conclusions ICG imaging technology is not effective in ordinary LC+LCBDE;ICG imaging technology is effective in difficult LC+LCBDE.It can assist the surgeon in judging the structure of the biliary tract,and reducing intraoperative damage.It can prevent operation-related bile leakage and has the advantages of the short operation time,fewer postoperative complications,shorter hospital stays,and less cost.This technology is worth promoting.Figure 4;Table 7;Reference 170... |
PDF Full Text Request