The Study On The Application Of Retrograde Indocyanine Green Fluorescence Imaging In Concurrent ERCP Combined With LC

Objective:To investigate the clinical application value of retrograde indocyanine green fluorescence imaging technique in concurrent endoscopic retrograde cholangiopancreatography combined with laparoscopic cholecystectomy.Selection methods:Sixty patients with cholecystolithiasis combined with choledocholithiasis admitted to Chifeng Clinical Medical College of Inner Mongolia Medical University from January 2021 to September2022 who underwent endoscopic retrograde cholangiopancreatography combined with laparoscopic cholecystectomy during the same period were selected.According to whether indocyanine green was injected into nasobiliary duct during the operation,retrograde cholecystolithography was performed.The patients were divided into fluorescence group and conventional group,with 30 patients in each group.After retrograde endoscopic cholangiopancreatography was inserted into the nasobiliary duct,the conventional group underwent cholecystectomy by laparoscope in general mode.In the fluorescence group,indocyanine green was injected into the nasobiliary duct for retrograde fluorescence imaging,and cholecystectomy was performed under laparoscopic fluorescence mode.Both groups were performed by the same surgical team.Combined with the general data of the two groups of patients,the results of preoperative and postoperative relevant laboratory tests,the operation time of cholecystectomy,intraoperative blood loss,postoperative hospital stay and other data,the differences of relevant data between the two groups of patients were compared and analyzed.Results:(1)The comparison results of general data between the two groups were as follows:Chi-square and independent sample T-test were used to compare the general data between the two groups,and there were no statistically significant differences in gender,age,height,weight,BMI,history of abdominal surgery,and preoperative complications between the two groups(P >0.05).Preoperative values of AST,ALT,GGT,TBIL,DBIL,WBC and HB were compared between the two groups,and there was no statistical significance in preoperative relevant test results between the two groups(P > 0.05).(2)The comparison results of intraoperative and postoperative relevant data between the two groups are as follows: The independent sample t test,non-parametric rank sum test and Chi-square test were used to compare and analyze the operative time of cholecystectomy,intraoperative blood loss,conversion to laparotomy rate,first postoperative test results and postoperative hospital stay of the two groups.Intraoperatie blood loss: fluorescent group ml(23.83 + 22.76)than in normal group(48.00 + 17.21)for ml,P = 0.000,the difference is statistically significant(P(27)0.05);Gallbladder surgery time: fluorescent group 60.00 73.00(46.00,71.3)min compared to conventional group(65.0,95.8)min,Z = 3.365,P = 0.001,statistically significant differences(P(27)0.05).There were 0cases in the fluorescence group and 1 case in the conventional group.There was no significant difference in the conversion rate between the two groups(P > 0.05).The results of AST,ALT,GGT,TBIL,DBIL,WBC,HB and postoperative hospital stay were compared between the two groups on the first day after surgery,and there was no significant difference in postoperative relevant laboratory results and postoperative hospital stay between the two groups(P > 0.05).(3)After intraoperative ICG injection through nasobiliary duct,the choledocholithography rate was 100%(30/30)in the fluorescence group,and the cholecystectomy duct and cholecystectomy rate was 90%(27/30).The average injection diluted ICG volume was 14.17ml(0.354mg),and the average intraoperative biliary tract fluorescence imaging time was 17.93 min.No bile duct injury or cholecystectomy with standard three-hole method instead of multi-hole method occurred in the two groups。Conclusions:1.The retrograde indocyanine green fluorescence imaging technique can reduce the operative time and intraoperative blood loss of laparoscopic cholecystectomy and increase the surgical safety in the simultaneous endoscopic retrograde cholecystectomy combined with laparoscopic cholecystectomy.Intraoperative indocyanine green imaging can effectively distinguish the extrahepatic bile duct system,provide guidance for intraoperative operation,and improve the efficiency and quality of surgery.2.The application of retrograde indocyanine green fluorescence imaging in concurrent endoscopic retrograde cholangiopancreatography combined with laparoscopic cholecystectomy is safe,efficient and feasible,and has good clinical application value and application prospect,worthy of promotion and application.