Yuan Miaoxian,Yin Qiang,Ji Chunyi,et al.Application of three-dimensional computed tomography reconstruction plus indocyanine green fluorescent staining technique in radical laparoscopy for congenital biliary dilatation[J].Journal of Clinical Pediatric Surgery,2020,19(07):614-618.[doi:10.3969/j.issn.1671-6353.2020.07.010]
三维CT重建联合ICG荧光染色技术在腹腔镜先天性胆管扩张症根治术中的应用
- Title:
- Application of three-dimensional computed tomography reconstruction plus indocyanine green fluorescent staining technique in radical laparoscopy for congenital biliary dilatation
- 关键词:
- 胆总管扩张症/外科学; 胆总管扩张症/先天性; 成像; 三维; ICG荧光染色
- Keywords:
- Choledochal Dilatation/SU; Choledochal Dilatation/CN; Imaging; Three-Dimensional; ICG Fluorescence Staining
- 分类号:
- R657.4;R445;R615
- 摘要:
- 目的 探讨三维CT重建联合ICG荧光染色在腹腔镜先天性胆管扩张症根治术中的应用价值。方法 回顾性分析2019年8月至11月湖南省儿童医院收治的10例经三维CT重建联合ICG荧光染色技术引导完成的腹腔镜先天性胆管扩张症根治术患儿临床资料，观察术中所见与术前规划的符合程度，并记录手术时间、术中出血量、住院时间、并发症等资料。结果 10例均在三维CT重建联合ICG荧光染色技术引导下顺利完成腹腔镜先天性胆管扩张症根治术，术前手术方案与实际手术方式符合率为100％；平均手术时间183.4 min，术中出血量10~35 mL，平均住院时间10.7d；术中1例发现胆漏，及时予以处理。患者均未出现ICG过敏、吻合口狭窄、胆漏、胰漏、胆管炎、胰腺炎等并发症。结论 三维CT重建联合ICG荧光染色技术可清晰显示扩张胆管的位置及其与相邻组织的解剖关系；预防血管等副损伤，提高手术质量，增加手术安全性，值得临床推广。
- Abstract:
- Objective To explore the application value of three-dimensional computed tomography (CT) reconstruction plus indocyanine green (ICG) fluorescent staining during radical laparoscopy of congenital cholangiectasia (CHD).Methods From August 2019 to November 2019,clinical data were retrospectively analyzed for 10 CHD children.And degree of conformity,operative duration,intraoperative bleeding volume,hospitalization stay and complications were observed.Results All CHD cases successfully completed radical laparoscopy under the guidance of three-dimensional CT reconstruction plus ICG fluorescent staining.The coincidence rate between preoperative operative plan and actual protocol was 100%;the average operative duration 183.4 min,the intraoperative bleeding volume 10-35 ml and the average hospitalization stay 10.7 days.One case of bile leakage was treated timely.There were no such complications as ICG allergy,anastomotic stenosis,bile leakage,pancreatic leakage,cholangitis or pancreatitis.Conclusion Three-dimensional CT reconstruction plus ICG fluorescent staining may distinctly delineate the location of dilated bile duct and depict its anatomical relationship with adjacent tissues.With heightened operative security,it is worthy of wider clinical applications.
参考文献/References:
1 Ishibashi H,Shimada M,Kamisawa T,et al.Japanese clinical practice guidelines for congenital biliary dilatation[J].J Hepato-biliary Pancreat Sci,2017,24(1):1-16.DOI:10.1002/jhbp.415.
2 中华人民共和国卫生卫生行业标准.WS385-2012先天性胆道畸形诊断标准[S].中国标准出版社:中华人民共和国国家质量监督检验检疫总局、中国国家标准化管理委员会2012. Health Industry Standard of the People’s Republic of China:Diagnostic Criteria for Congenital Biliary Malformations[S].
3 Qiao GL,Li L,Li SL,et al.Laparoscopic cyst excision and Roux-Y hepaticojejunostomy for children with choledochal cysts in China:a multicenter study[J].Surgical endoscopy,2015,29(1):140-144.DOI:10.1007/s00464-014-3667-7.
4 Liu Y,Diao M,Li L.Using laparoscopic double hemicircum-ferential running single-layer suture in hepaticojejunostomy for choledochal cysts in children[J].J Pediatr Surg,2018,53(1):199-202.DOI:10.1016/j.jpedsurg.2017.09.015.
5 Sica M,Molinaro F,Angotti R,et al.Choledochal cysts:Early experience by Laparoscopic approach[J].Journal of Pediatric Surgery Case Reports,2016,11(C):4-6.DOI:10.1016/j.epsc.2016.05.003.
6 Todani T,Watanabe Y,Narusue M,et al.Congenital bile duct cysts:Classification,operative procedures,and review of thirty-seven cases including cancer arising from choledochal cyst[J].Am J Surg,1977,134(2):263-269.DOI:10.1016/0002-9610(77)90359-2.
7 高志刚,章跃滨,蔡多特,等.腹腔镜胆总管囊肿根治术205例并发症分析及经验总结[J].临床小儿外科杂志,2017,16(1):65-69.DOI:10.3969/j.issn.1671-6353.2017.01.015. Gao ZG,Zhang YB,Cai DT,et al.Analysis and experience of complications of radical laparoscopy for choledochal cyst:a report of 205 cases[J].J Clin Ped Sur,2017,16(1):65-69.DOI:10.3969/j.issn.1671-6353.2017.01.015.
8 Guo J,Dong Q,Fang Z,et al.Identification of miRMAs that are associated with tumor metastasis in neuroblastoma[J].Cancer Biol Ther,2010,9(6):446-452.DOI:10.4161/cbt.9.6.10894.
9 苏琳,董蒨,张虹,等.计算机辅助手术系统在先天性胆管扩张症诊治中的应用[J].临床小儿外科杂志,2016,15(2):140-143.DOI:10.3969/j.issn.1671-6353.2016.02.012. Su L,Dong Q,Zhang H,et al.Application of computer-aided surgical system in the diagnosis and treatment of congenital cholangiectasia[J].J Clin Ped Sur,2016,15(2):140-143.DOI:10.3969/j.issn.1671-6353.2016.02.012.
10 Rubens FD,Ruel M,Fremes SE.A new and simplified method for coronary and graft imaging during CABG[J].Heart Surg Forum,2002,5(2):141-144.DOI:10.1002/hed.1156.
11 Hitier M,Cracowski JL,Hamou C,et al.Indocyanine green fluorescence angiography for free flap monitoring:A pilot study[J].J Craniomaxillofac Surg,2016,44(11):1833-1841.DOI:10.1016/j.jcms.2016.09.001.
12 Koh FH,Tan KK.Fluorescent angiography used to evaluate the perfusion status of anastomosis in laparoscopic anterior resection[J].Ann Surg Oncol,2016,23(Suppl 5):692.DOI:10.1245/s10434-016-5581-9.
13 Guillén G,López-Fernández S,Molino JA,et al.Pilot experience with indocyanine green navigation in pediatric surgery[J].Cir Pediatr,2019,32(3):121-127.
14 Schols RM,Connell NJ,Stassen LP.Near-infrared fluorescence imaging for real-time Intraoperative anatomical guidance in minimally invasive surgery:a systematic review of the literature[J].World J Surg,2015,39(5):1069-1079.DOI:10.1007/s00268-014-2911-6.
15 胡浩宇.三维可视化联合吲哚菁绿荧光成像技术在胆道损伤及肝癌诊疗的应用研究[D].南方医科大学,2018:1-72. Hu HY.Application of 3D visualization combined with indocyanine green fluorescence imaging in the diagnosis and treatment of biliary tract injury and liver cancer[D].Southern Medical University,2018:1-72.
16 Speich R,Saesseli B,Hoffmann U,et al.Anaphylactoid reactions after indocyanine green administration[J].Ann Intern Med,1988,109(4):345-346.DOI:10.7326/0003-4819-109-4-345_2.
17 Manoj KS,Rajagopalan.Choledochal cyst[J].Medical Journal Armed Forces India,2012,68(3):296-298.DOI:10.1016/j.mjafi.2012.04.011.
备注/Memo
收稿日期:2019-05-18。
基金项目:湖南省卫健委重点专科建设技术创新项目（编号：湘卫医政医管处函[2018]187号）
通讯作者:尹强,Email:qiangyin@hotmail.com