Clinical Application Of Indocyanine Green Fluorescence Imaging In Biliary Recognition And Navigation During Difficult Biliary Surgery

Objective: The purpose of this study is to explore the clinical value of indocyanine green fluorescence imaging in biliary tract recognition and navigation in difficult biliary tract surgery by using hand-held near-infrared light system and synthesizing the uptake and metabolism mechanism of indocyanine green(ICG)by hepatocytes.Methods : To collect the clinical data of 40 patients with history of biliary tract surgery admitted to Department of Hepatobiliary Surgery,Affiliated Hospital of Southwest Medical University from April 01,2018 to March 30,2019,who need to undergo biliary tract exploration again and meet the criteria of difficult biliary tract grouping.Among them,25 males and 15 females,aged 46-78,had a history of biliary surgery(n=28),two biliary surgery(n=8),three biliary surgery(n=3),and four biliary surgery(n=1).Forty patients were randomly divided into control group and experimental group,including 15 cases in the control group,using traditional open biliary tract recognition method,and 25 cases in the experimental group.Fluorescence imaging was used to detect biliary tract.The fluorescence intensity of fluorescent images was measured by imageJ software after operation to explore the optimal injection time of indocyanine green in intraoperative difficult biliary near infrared fluorescence imaging.At the same time,the intraoperative and postoperative conditions of the two groups of patients were compared,and the effect and safety of fluorescence technique in difficult biliary tract surgery were evaluated.Quantitative data in this study were expressed by mean ±standard deviation(X±S),while qualitative data were expressed as ratios.SPSS statistical software 17.0 was used for statistical analysis,K-S test was used to test the orthodoxy of data,Levene test was used to test the variance homogeneity of fluorescence intensity of five groups,variance analysis was used to compare the difference of fluorescence intensity of five groups,and one-way ANOVA was used to compare the intraoperative and postoperative related indicators of two samples.The P value <0.05 was considered to be statistically significant.Results:(1)Feasibility study of 20 cases of normal bile duct imaging: When 2.5 mg of indocyanine green was injected intravenously,part of the biliary tract began to identify in about 15 minutes,and the extrahepatic bile duct was imaged in about 45 minutes.(2)The optimal injection time for ICG: 25 patients who underwent fluorescent biliary visualization successfully identified the biliary tract during surgery.Among the five groups of experiments,there was a significant difference between the 30 min group and the 60 min,90 min,and 120 min groups(P<0.05).There was no significant difference between the 30 min group and the 150 min group(P>0.05).There was no significant difference between the 60 min group and the 90 min and 120 min groups(P>0.05).There was significant difference between the 60 min group and the 150 min group(P<0.05).There was no significant difference between the 90 min group and the 120 min group(P>0.05).There was a significant difference between the 90 min group and the 150 min group(P<0.05).There was significant difference between the 120 min group and the 150 min group(P<0.05).(3)The effect and safety of identifying extrahepatic difficult bile duct: ○1 The operation time of the traditional control group was significantly longer than that of the experimental group(60 min,90 min group)(P < 0.05),and the comparison between the groups suggested that the operation time of the 90 min group was significantly shorter than the 120 min group.○2Compared with the control group,the time spent in searching for bile duct in 90 minutes group was significantly shorter(P < 0.05).○3(3)Compared with the control group,the intraoperative bleeding volume in the 90-minute experimental group was less,and that 90 min group less than 120 min group(P<0.05).○4 In the traditional control group,there were 1 case of biliary tract injury,1 case of bile leakage,2 cases of abdominal infection,and the incidence of postoperative complications was 26.67%(4/15).In the experimental group,1 case of postoperative infection was found,and no complications such as bile duct injury and bile leakage were found.The incidence of postoperative infection in 60 min group was significantly lower than that in control group(P < 0.05),and the incidence of postoperative infection in 90 min group was also lower than that in control group(P < 0.05).The incidence of postoperative infection in 90 min group was also lower than that in 120 group(P < 0.05),the incidence of postoperative infection in 60 min group was also lower than that in 120 group(P < 0.05).There were no deaths in both the experimental group and control group.Conclusion: 1.Indocyanine green fluorescence imaging technology has high feasibility in detecting extrahepatic bile ducts.2.In difficult biliary surgery,the fluorescence imaging effect is better when 2.5 mg ICG is injected 60-120 minutes later.3.Fluorescence imaging technique is reliable in detecting and locating extrahepatic bile duct in difficult biliary surgery.It can help surgeons locate extrahepatic bile duct and has good clinical application value.