| Objective:To study the role of indocyanine green(ICG)fluorescence imaging technology in the identification of biliary tract during laparoscopic difficult biliary surgery.Methods:Retrospective analysis of clinical data of 54 patients undergoing laparoscopic difficult biliary surgery admitted to the Second Affiliated Hospital of Kunming Medical University from August 2019 to August 2022.Among them,25 underwent ICG fluorescence imaging surgery(fluorescence imaging group)and 29 underwent conventional laparoscopic surgery(conventional hand surgery group).The general data(gender,age,epigastrium surgery history),preoperative data [alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),direct bilirubin(DBIL)] Differences in intraoperative indicators(surgical time,bile duct search time,intraoperative bleeding volume,conversion to open surgery rate),postoperative indicators(extubation time,exhaust time,hospitalization time,total hospitalization cost),and incidence of complications(biliary tract injury,bile leakage,intestinal injury).Results:(1)Before operation: patients in the fluorescence imaging group had sex(14 males,11 females),age(58.44 ± 13.02 years),upper abdominal surgery history(13 patients with a history of primary biliary surgery,6 patients with a history of secondary biliary surgery,1 patient with a history of third biliary surgery,3 patients with a history of partial hepatectomy,and 2 patients with a history of gastric surgery),ALT: 81.80 ± 39.24U/L,AST: 75.52 ± 46.26U/L,TBIL: 30.66 ± 13.84umol/L,DBIL:17.64 ± 11.87umol/L,There was no statistically significant difference between the patients in the conventional surgery group(12 males and 17 females),age(56.21 ±9.47 years),upper abdominal surgery history(15 patients with a history of primary biliary surgery,5 patients with a history of secondary biliary surgery,2 patients with a history of third biliary surgery,4 patients with a history of partial hepatectomy,and 3patients with a history of gastric surgery),ALT: 89.89 ± 30.31U/L,AST: 81.79 ±35.25U/L,TBIL: 32.26 ± 19.57umol/L,DBIL: 19.87 ± 14.22umol/L(all P>0.05);(2)During operation: compared with the conventional operation group,the operation time(110.68 ± 19.03 min vs 147.83 ± 28.59 min),the time to find the bile duct during operation(30.92 ± 9.72 min vs 56.52 ± 18.84 min),and the intraoperative bleeding volume(43.61 ± 30.67 m L vs 87.93 ± 15.67 m L)in the fluorescence imaging group were significantly reduced(P<0.05);The conversion rate to laparotomy(0% vs 13.8%)was not statistically significant(P>0.05);(3)After operation: compared with the conventional operation group,the postoperative exhaust time(1.84 ± 0.80 days vs2.97 ± 0.49 days),postoperative extubation time(3.24 ± 2.26 days vs 5.38 ± 0.73days),postoperative hospital stay(5.16 ± 2.89 days vs 7.14 ± 1.27 days),and total hospital expenses(26143.71 ± 2429.51 yuan vs 28910.68 ± 4404.55 yuan)in the fluorescence imaging group were significantly reduced(P<0.05).Postoperative bile leakage occurred in 1 case in the fluorescence imaging group,bile duct injury in 3cases,bile leakage in 3 cases,and intestinal injury in 2 cases in the conventional operation group.Compared with the conventional operation group,the total postoperative complication rate in the fluorescence imaging group was significantly lower(4.0% vs 27.5%),and the difference was statistically significant(P=0.028).Conclusions:The ICG fluorescence imaging technology can display the biliary system in real time during the operation.Compared with conventional laparoscopic surgery,it can reduce the amount of intraoperative bleeding,shorten the operation time,reduce the time to find the bile duct during the operation,reduce the incidence of surgical complications,improve the operation safety,reduce the burden of patients,and has good clinical application value. |
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