| Research background:Laparoscopic cholecystectomy(LC)is one of the most common operations in general surgery,and it’s operation technology has been very mature.For experienced surgeons,conventional LC is not too difficult,but for relatively complex cases such as partial anatomical structure variation,unclear anatomical structure of gallbladder triangle caused by long-term chronic inflammation and acute attack of gallbladder inflammation,The probability of bile duct injury(BDI)during surgery will increase significantly.In order to reduce the occurrence of BDI during surgery as much as possible,more and more surgeons have begun to explore the real-time imaging technology of anatomical structure during surgery based on the anatomical structure development of preoperative imaging.Compared with traditional imaging,these technologies can further clarify the anatomical structure in the field during surgery,thus enhancing the confidence of surgeons,Reduce the occurrence of surgical complications.In recent years,the use of indocyanine green(ICG)real-time fluorescence imaging to protect the biliary tract during LC has gradually developed.This paper will study the application of ICG in LC.Objective:1.To compare the effect of ICG fluorescence imaging LC and ordinary white light LC,verify the role of ICG fluorescence imaging in LC,and study the feasibility of ICG fluorescence imaging in extrahepatic biliary protection surgery.2.Analyze the differences in the progress of ICG fluorescence development that have not reached consensus,and discuss the recommended ICG injection dose.Materials and Methods:120 patients with benign diseases of the gallbladder were selected from the Department of Jilin second Class Hospital from November 2021 to October 2022.These 120 patients were diagnosed as suffering from benign diseases of the gallbladder,such as gallstone,cholecystitis,gallstone with cholecystitis,gallbladder polyps,and so on by relevant imaging examination and laboratory examination.Among them,60 patients with ICG fluorescence LC were set as the experimental group,All of the 60 patients have signed informed consent forms and comply with medical and nursing operational practices and ethical requirements,and the other 60 patients with ordinary white light LC were set as the control group,Compare the experimental group with the control group.In the experimental group,45 cases were divided into group A,group B and group C according to the preoperative dose.The time and method of administration were slow peripheral intravenous injection 30 minutes before operation.Group A was given 0.5mg ICG,group B was given0.75 mg ICG,and group C was given 1.0mg ICG for comparison within the experimental group.The patient’s sex,age,body mass index,abdominal adhesion history,liver cirrhosis history,preoperative total bilirubin,intraoperative biliary tract recognition time,intraoperative bleeding,operation time,Postoperative total bilirubin,postoperative complications(bile leakage,peritoneal effusion,incision infection),hospital stay,hospital expenses and other data were counted.SPSS27.0 was used for statistical analysis of the above collected data.All count data were expressed in frequency or percentage,and were compared with chi-square test.When comparing the experimental group with the control group,the quantitative data conforming to the normal distribution was expressed by the mean ±standard deviation,and compared by using two independent sample t test methods.The quantitative data not conforming to the normal distribution was expressed by the median(interquartile interval),and compared by using two independent sample non-parametric Mann-Whitney U test methods.During the intra-group comparison,the quantitative data conforming to the normal distribution is expressed by the mean± standard deviation,and compared by the one-way ANOVA test method.The quantitative data not conforming to the normal distribution is expressed by the median(interquartile interval),and compared by the Kruskal-Wallis test method.P<0.05 was considered statistically significant.The image J software was used to measure the fluorescence intensity of the liver and bile duct in the three groups of fluorescence images in the experimental group,calculate the ratio of the fluorescence intensity,and discuss the recommended ICG injection dose.Results:(1)Comparison between the experimental group and the control group: There was no statistical difference between the two groups in terms of sex(P=0.356),age(P=0.368),body mass index(P=0.704),history of abdominal adhesion(P=0.690),history of liver cirrhosis(P=0.261),total bilirubin(P=0.132),etc;Comparison of intraoperative and postoperative basic data showed that there were statistical differences between the two groups in terms of bile duct identification time(P<0.01)、intraoperative blood loss(P<0.01)、operation time(P=0.010)、hospital stay(P=0.035),and hospital expenses(P<0.01).In the experimental group,the intraoperative biliary tract identification time is short,the intraoperative blood loss is small,the operation time is short,the hospital stay is short,and the hospital expenses are small Compared with the control group,the experimental groups have advantages.There is no statistical difference in biliary leakage(P=0.309)、Postoperative total bilirubin(P=0.867),postoperative peritoneal effusion(P=0.609),postoperative incision infection(P=0.783).(2)Comparison within the experimental group: the comparison of basic data before operation showed that there were no statistical differences among the three groups in terms of sex(P=0.915),age(P=0.185),body mass index(P=0.861),abdominal adhesion history(P=0.879),history of liver cirrhosis(P=0.879),and preoperative total bilirubin(P=0.558);Comparison of intraoperative and postoperative data showed that there was no statistical difference between the three groups in terms of intraoperative biliary tract identification time(P=0.163),intraoperative blood loss(P=0.259),operation time(P=0.542),postoperative total bilirubin(P=0.387),postoperative peritoneal effusion(P=0.844),biliary leakage(P=0.360),postoperative incision infection(P=0.844),hospital stay(P=0.220),and hospital expenses(P=0.582),That is,different doses of ICG given to patients through peripheral vein 30 minutes before operation will not affect the operation effect to a certain extent.(3)Use Image J software to measure the fluorescence intensity of 3 randomly selected points in the common bile duct and liver regions in the collected fluorescence imaging,and take the average value as the fluorescence intensity of the common bile duct and liver.The CBD fluorescence intensity in Group A was 160.96± 2.02 A.U.,the CBD fluorescence intensity in Group B was 162.46 ± 1.97 A.U.,and the CBD fluorescence intensity in Group C was 163.59 ± 2.16 A.U.,P<0.05.There were statistical differences among the three groups;The fluorescence intensity of the liver in Group A was 163.35 ± 2.08 A.U.,the fluorescence intensity of the liver in Group B was 168.88 ± 2.66 A.U.,and the fluorescence intensity of the liver in Group C was 172.49 ± 1.95 A.U.,P<0.05.The data of the three groups were statistically different.With the increase of the dose,the fluorescence intensity of CBD and liver also increased.The fluorescence intensity of Group B and Group C was greater than that of Group A.The contrast value of the fluorescence intensity in Group B was 0.025 ± 0.007,and the contrast value of the fluorescence intensity in Group C was 0.035 ± 0.010,P<0.05,There are statistical differences between the two groups.Group B is smaller than Group C,that is,the interference degree of liver background fluorescence in Group B is smaller than that in Group C.The dosage of0.75 mg in Group B can be used as the recommended dosage of ICG 30 minutes before operation.Conclusion:1.ICG fluorescent LC is safe and effective,and can be used in extrahepatic biliary protection surgery.Compared with traditional white light LC,it can identify the biliary tract more quickly,reduce the incidence of BDI,reduce the amount of intraoperative bleeding,speed up the process of surgery,and complete the surgery faster and more safely on the premise of ensuring the surgical effect.2.The results of this study suggest that a clear and stable fluorescence image can be obtained by slowly injecting 0.75 mg ICG into peripheral vein 30 minutes before operation. |
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