Xu Chen,Tang Yue,Zheng shan,et al.Study of real-time imaging with indocyanine green during hepatoportoenterostomy as a prognostic factor in children with biliary atresia[J].Journal of Clinical Pediatric Surgery,,21():738-745.[doi:10.3760/cma.j.cn101785-202111058-007]
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Study of real-time imaging with indocyanine green during hepatoportoenterostomy as a prognostic factor in children with biliary atresia

Journal of Clinical Pediatric Surgery[ISSN:1671-6353/CN:43-1380/R] volume: 第21卷 Number: 2022 08 Page: 738-745 Column: 论著 Date of publication: 2022-08-28
Author(s):
Xu Chen1;  Tang Yue2;  Zheng shan1;  Huang Yanlei1;  Yang Shaobo1;  Sun Song1;  Li Jun1;  Zhu Ye3;  Liu Yuanxin4;  Song Zai1;  Dong Chenbin1;  Chen Gong1
1. National Children’s Medical Center (shanghai), Children’s Hospital of Fudan University, Department of Pediatric Surgery, Shanghai 201102;
2. National Children’s Medical Center (Shanghai), Children’s Hospital of Fudan University, Department of Neurosurgery, Shanghai 201102;
3. National Children’s Medical Center (Shanghai), Children’s Hospital of Fudan University, Department of Anesthesiology, Shanghai 201102;
4. National Children’s Medical Center (Shanghai), Children’s Hospital of Fudan University, Department of Medical Ultrasonography, Shanghai 201102, China
Keywords:
Biliary Atresia/DI; Biliary Atresia/SU; Fluorescent Dyes; Indocyanine Green; Prognosis; Forecasting
DOI:
10.3760/cma.j.cn101785-202111058-007
Abstract:
Objective Indocyanine green (ICG) facilitates real-time imaging of bile outflow during Kasai procedure.This study was to explore the relationship between the characteristics of liver fluorescent imaging during Kasai with ICG and early prognosis of children with biliary atresia (BA).Methods From November 2019 to May 2020,87 children with type Ⅲ BA undergoing ICG-FCG were retrospectively reviewed.There were 38 boys and 49 girls with an operative age of (60.49±20.75) day and an average weight of (4.83±0.76) kg.Porta hepatis (PH) and liver were examined intraoperatively with a near-infrared camera system and lightness values of special sites calculated for further analysis.For seeking the potential correlation between ICG-FCG and outcome,(ⅰ) enhanced imaging,(ⅱ) delayed imaging and (ⅲ) stable imaging were sub-grouped by dynamic images of PH;(A) spotty fluorescence;(B) diffuse strong fluorescence;(C) diffuse weak fluorescence based upon fluorescent patterns of liver surface.Ratio of lightness ratio of PH was calculated and the relationship was compared between bile excretion,bile distribution and transient bile flow and early prognosis in each group.The early endpoints were the 3/6-month postoperative jaundice clearance rate (JCR) and 1-year native liver survival rate (NLS).Results The overall JCR at Month 3/6 were 49.4% and 59.8% respectively and 1-year NLS was 59.8%.There were group ⅰ(n=66),group ⅱ(n=5) and group ⅲ(n=16) and JCR at Month 6 was 62.1%(41/66)、60%(3/5) and 50%(8/16) respectively (χ2=0.929,P=0.679).In group ii,direct bilirubin was similar to preoperative levels at Week 1/2/4 post-operation and ultimately it attained the same low-level as two other groups at Month 6.The overall data revealed no difference in declining rate of bilirubin (P=0.0641) among the group A (n=33),group B (n=40) and group C (n=14).And JCR at Month 6 was 57.6%,62.5% and 57.1% respectively (χ2=0.299,P=0.876).There was no difference in declining rate of bilirubin among three groups (P=0.923).Ratio of lightness ratio of PH was not correlated with 6-month JCR according to univariate analysis (P=0.432).Conclusion In children with type Ⅲ BA with slow bile excretion,it takes longer for jaundice to resolve.The Results of intraoperative bile excretion velocity,bile distribution and instantaneous bile flow using ICG show no marked correlation with early jaundice clearance and survival.

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Memo

收稿日期:2021-11-26。
基金项目:上海市临床重点专科(shslczdzk05703);国家儿童医学中心"登峰"交叉创新团队(EK112520180211);医苑新星杰出青年医学人才2018(EK00000622);上海市科委西医引导项目(No.18411969100);国家自然基金面上项目(No:81873545)
通讯作者:陈功,Email:chengongzlp@hotmail.com

Last Update: 1900-01-01