| Objective(s):By comparing the study of traditional laparoscopic cholecystectomy(LC)and laparoscopic cholecystectomy under fluorescence navigation with direct injection of indocyanine green(ICG)through the gallbladder during the operation,the application value of fluorescence navigation with intracystic injection of ICG in laparoscopic cholecystectomy was discussed.Methods: The clinical data of 60 patients with gallbladder stones and cholecystitis who underwent LC in the Hepatobiliary Department of the Second Affiliated Hospital of Kunming Medical University from September 2020 to February2022 were selected for research and analysis.All patients have signed relevant informed consent forms,which comply with medical ethics regulations.Patients were randomly divided into a fluorescence group(30 cases)and a control group(30 cases)based on whether ICG fluorescence navigation was used during surgery.Observe and compare the general situation of patients,gallbladder duct recognition rate,common bile duct recognition rate,intraoperative bleeding volume,time for dissecting the gallbladder triangle,time for separating the gallbladder bed,surgical time,postoperative complications,and conversion to laparotomy between the two groups.SPSS 25.0 statistical software was used for data analysis.The gallbladder duct recognition rate and common bile duct recognition rate between the two groups were compared using x2 test,the gallbladder bed separation time and surgical time were compared using t-test,the bleeding volume was compared using rank sum test,and the conversion to open surgery and postoperative complications were compared using Fisher’s exact probability method.P<0.05 indicates a statistically significant difference.Results:(1)This study included a total of 60 cases ranging in age from 22 to70 years with a median age of 49.5.Thirty cases were included in fluorescence group,including male: 14,female: 16,mean age: 48 ± 11 years,BMI: 23.9 ± 1.9,including 9 patients with a previous history of hypertension,7 patients with a previous history of diabetes mellitus,4 patients with a previous history of coronary heart disease,and 3 patients with a previous history of abdominal surgery;Thirty cases were included in the control group: male: 17,female: 13,mean age: 49 ± 11 years,BMI: 23.7 ± 1.3,including 11 patients with a previous history of hypertension,5patients with a previous history of diabetes mellitus,3 patients with a previous history of coronary heart disease,and 2 patients with a previous history of abdominal surgery;No significant difference was found when comparing the two groups regarding basic information such as gender,age,BMI,and underlying diseases(P > 0.05)(2)Comparing the various intraoperative observation data in the two groups,it can be found that before dissection of the gallbladder triangle,the identification rate of the gallbladder tube(8 / 30,26.7%)and the common bile duct(10 / 30,33.3%)in the control group was significantly lower than the identification rate of the gallbladder tube(23 / 30,76.6%)and the common bile duct(26 / 30,86.6%)in the fluorescence group;The complete anatomical gallbladder triangle time(10.6 ± 3.5)min,separated gallbladder bed time(15.7 ± 5.5)min,and operative time(57.9 ± 13.6)min in the LC control group were significantly longer than the complete anatomical gallbladder triangle time(8.4 ± 2.5)min,separated gallbladder bed time(10.9 ± 3.4)min,and operative time(49.8 ± 9.9)min in the fluorescence group;The intraoperative blood loss in the control group was 22.5(26.25 to 15)ml,which was also more than the blood loss of 15(16.25 to 10)ml in the fluorescence group;One case of intraoperative conversion to open abdomen in the control group and no cases of intraoperative conversion to open abdomen in the fluorescence group;The comparison of the two groups showed significant differences in the rate of identification of the cystic duct,the rate of identification of the common bile duct,the time to complete dissection of the gallbladder triangle,the time to separate the gallbladder bed,the operative time and the amount of intraoperative blood loss(P < 0.05);There was no significant difference in conversion to laparotomy between the two groups(P > 0.05).(3)The procedure was successfully performed in both the fluorescence and control groups,with no perioperative deaths.The total number of surgical complications was 1 in the fluorescence group,including 1 incision infection without biliary injury and postoperative bleeding,and 7 in the control group,including 3 incision infections,2biliary injuries,and 2 postoperative bleeding.When compared by Fisher’s exact probability method,the total number of complications in the two groups,the difference was statistically significant(P < 0.05),while when comparing the two groups biliary tract injury,postoperative bleeding,incision infection alone,the difference was not statistically significant(P > 0.05).Conclusion(s): For this study,compared with conventional LC,fluorescence navigation using ICG via gallbladder injection in LC can not only help the operator to effectively discern the anatomical space between the liver and gallbladder intraoperatively,improve the identification rate of cystic duct,common bile duct and variant biliary tract,and thus reduce the incidence of iatrogenic biliary injury,but also alert the operator to the role of undeveloped duct and reduce intraoperative bleeding when encountered intraoperatively The advantages of less postoperative complications,less time to dissect the gallbladder triangle,time to separate the gallbladder bed,and operative time were minimized.These advantages suggest that ICG via gallbladder injection has safety and efficacy in the use of LC,and has certain application value and promotion value in the clinic. |
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