[1]徐琛,汤悦,郑珊,等.Kasai术中肝脏吲哚菁绿显像特点与胆道闭锁患儿早期预后的关系探索[J].临床小儿外科杂志,2022,21(08):738-745.[doi:10.3760/cma.j.cn101785-202111058-007]
　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,2022,21(08):738-745.[doi:10.3760/cma.j.cn101785-202111058-007]
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Kasai术中肝脏吲哚菁绿显像特点与胆道闭锁患儿早期预后的关系探索

《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R] 卷: 第21卷 期数: 2022年08期 页码: 738-745 栏目: 论著 出版日期: 2022-08-28
Title:
Study of real-time imaging with indocyanine green during hepatoportoenterostomy as a prognostic factor in children with biliary atresia
作者:
徐琛1;  汤悦2;  郑珊1;  黄焱磊1;  杨少波1;  孙松1;  李军1;  朱叶3;  刘源鑫4;  宋再1;  董晨彬1;  陈功1
1. 国家儿童医学中心, 复旦大学附属儿科医院外科, 上海 201102;
2. 国家儿童医学中心, 复旦大学附属儿科医院神经外科, 上海 201102;
3. 国家儿童医学中心, 复旦大学附属儿科医院麻醉科, 上海 201102;
4. 国家儿童医学中心, 复旦大学附属儿科医院超声科, 上海 201102
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
关键词:
胆道闭锁/诊断; 胆道闭锁/外科学; 荧光染料; 吲哚菁绿; 预后; 预测
Keywords:
Biliary Atresia/DI; Biliary Atresia/SU; Fluorescent Dyes; Indocyanine Green; Prognosis; Forecasting
DOI:
10.3760/cma.j.cn101785-202111058-007
摘要:
目的 本研究探索在Kasai术中使用ICG后的肝脏荧光显像特点与胆道闭锁早期预后的关系。方法 本研究纳入2019年11月至2020年5月在复旦大学附属儿科医院外科行胆道探查与Kasai手术的Ⅲ型胆道闭锁患儿共87例,其中男38例,女49例,手术日龄(60.49±20.75) d,体重(4.83±0.76) kg。术前1天注射ICG。术中用近红外摄像系统观察肝门部及肝脏表面ICG荧光显像特点,计算相应部位的亮度值。根据肝门部显像快慢(快显像为ⅰ组,慢显像为ⅱ组,不显像为ⅲ组)、肝脏表面荧光特征(点状荧光为A组,均匀强荧光为B组,均匀弱荧光为C组)以及肝门部亮度比值比分别进行亚组分析,比较各组胆汁排泄速度、胆汁分布及瞬时胆汁流量与早期预后的关系。早期预后指标为术后3个月、6个月退黄率及术后1年自体肝生存率。结果 87例患儿术后3个月、6个月总体退黄率分别为49.4%和59.8%,术后1年自体肝生存率为59.8%。其中ⅰ组(n=66)、ⅱ组(n=5)和ⅲ组(n=16)术后6个月退黄率分别为62.1%(41/66)、60%(3/5)和50%(8/16)(χ2=0.929,P=0.679),ⅱ组术后1个月内各时间点(术后7天、14天、1个月)的血清胆红素数值与术前相似,但三组患儿术后6个月内胆红素总体下降趋势比较差异无统计学意义(P=0.0641)。A组(n=33),B组(n=40)和C组(n=14)术后6个月退黄率分别为41/66、3/5和8/16,(χ2=0.299,P=0.876),组间术后6个月内退黄趋势比较差异无统计学意义(P=0.923)。肝门部亮度比值比与术后6个月退黄无关(P=0.432)。结论 Ⅲ型胆道闭锁Kasai术中胆汁排泄慢的患儿黄疸消退需要更长时间,术中使用ICG检测肝门胆汁排泄速度、胆汁分布及瞬时胆汁流量结果与术后BA患儿早期退黄和生存情况无明显相关性。
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.

参考文献/References:

[1] Hirayama Y,Iinuma Y,Yokoyama N,et al.Near-infrared fluorescence cholangiography with indocyanine green for biliary atresia.Real-time imaging during the Kasai procedure:a pilot study[J].Pediatr Surg Int,2015,31(12):1177-1182.DOI:10.1007/s00383-015-3799-4.
[2] Yanagi Y,Yoshimaru K,Matsuura T,et al.The outcome of real-time evaluation of biliary flow using near-infrared fluorescence cholangiography with Indocyanine green in biliary atresia surgery[J].J Pediatr Surg,2019,54(12):2574-2578.DOI:10.1016/j.jpedsurg.2019.08.029.
[3] Reinhart MB,Huntington CR,Blair LJ,et al.Indocyanine green:historical context,current applications,and future considerations[J].Surg Innov,2016,23(2):166-75.DOI:10.1177/1553350615604053.
[4] Goldstein SD,Heaton TE,Bondoc A,et al.Evolving applications of fluorescence guided surgery in pediatric surgical oncology:A practical guide for surgeons[J].J Pediatr Surg,2021,56(2):215-223.DOI:10.1016/j.jpedsurg.2020.10.013.
[5] Cho YJ,Namgoong JM,Kwon HH,et al.The advantages of indocyanine green fluorescence imaging in detecting and treating pediatric hepatoblastoma:a preliminary experience[J].Front Pediatr,2021,9:635394.DOI:10.3389/fped.2021.635394.
[6] Leon P,Panaro F.Intra-operative trans-cystic indocyanine green (ICG) cholangiography:a high-sensitive method to identify bile leakage after hepatic resection[J].Hepatobiliary Surg Nutr,2020,9(2):260-262.DOI:10.21037/hbsn.2019.12.08.
[7] Nielsen J,Nerup N,M?ller S,et al.Minimally invasive assessment of hepatic function in children with indocyanine green elimination:a validation study[J].Scand J Gastroenterol,2019,54(4):485-491.DOI:10.1080/00365521.2019.1591497.
[8] Quintero J,Miserachs M,Ortega J,et al.Indocyanine green plasma disappearance rate:a new tool for the classification of paediatric patients with acute liver failure[J].Liver Int,2014,34(5):689-694.DOI:10.1111/liv.12298.
[9] Chan A,Kow A,Hibi T,et al.Liver resection in Cirrhotic liver:Are there any limits?[J].Int J Surg,2020,82S:109-114.DOI:10.1016/j.ijsu.2020.06.050.
[10] 尹强.吲哚菁绿荧光成像技术在小儿外科领域的应用与局限[J].临床小儿外科杂志,2021,20(10):901-905.DOI:10.12260/lcxewkzz.2021.10.001. Yin Q.Application and prospect of indocyanine green fluorescence imaging in pediatric surgery[J].J Clin Ped Sur,2021,20(10):901-905.DOI:10.12260/lcxewkzz.2021.10.001.
[11] Sasaki H,Nio M,Ando H,et al.Anatomical patterns of biliary atresia including hepatic radicles at the porta hepatis influence short-and long-term prognoses[J].J Hepatobiliary Pancreat Sci,2021,28(11):931-941.DOI:10.1002/jhbp.989.
[12] Morecki R,Glaser JH,Cho S,et al.Biliary atresia and reovirus type 3 infection[J].N Engl J Med,1982,307(8):481-484.DOI:10.1056/NEJM198208193070806.
[13] Mirza Q,Kvist N,Petersen BL.Histologic features of the portal plate in extrahepatic biliary atresia and their impact on prognosis-a Danish study[J].J Pediatr Surg,2009,44(7):1344-1348.DOI:10.1016/j.jpedsurg.2008.11.054.
[14] Matsuo S,Ikeda K,Yakabe S,et al.Histological study of the remnant of porta hepatis in patients with extrahepatic biliary atresia-A computed picture analysis of 30 cases[J].Z Kinderchir,1984,39(1):46-49.DOI:10.1055/s-2008-1044168.
[15] Chusilp S,Sookpotarom P,Tepmalai K,et al.Prognostic values of serum bilirubin at 7th day post-Kasai for survival with native livers in patients with biliary atresia[J].Pediatr Surg Int,2016,32(10):927-931.DOI:10.1007/s00383-016-3951-9.
[16] Wang Z,Chen Y,Peng C,et al.Five-year native liver survival analysis in biliary atresia from a single large Chinese center:The death/liver transplantation hazard change and the importance of rapid early clearance of jaundice[J].J Pediatr Surg,2019,54(8):1680-1685.DOI:10.1016/j.jpedsurg.2018.09.025.
[17] Shneider BL,Magee JC,Karpen SJ,et al.Total serum bilirubin within 3 months of hepatoportoenterostomy predicts short-term outcomes in biliary atresia[J].J Pediatr,2016,170:211-217.e1-2.DOI:10.1016/j.jpeds.2015.11.058.
[18] Chiang LW,Lee CY,Krishnaswamy G,et al.Seventeen years of Kasai portoenterostomy for biliary atresia in a single Southeast Asian paediatric centre[J].J Paediatr Child Health,2017,53(4):412-415.DOI:10.1111/jpc.13379.
[19] Takimoto A,Sumida W,Amano H,et al.Postoperative intestinal obstruction in patients with biliary atresia impedes biliary excretion and results in subsequent liver transplantation[J].Pediatr Surg Int,2021,37(2):229-234.DOI:10.1007/s00383-020-04807-9.
[20] Chen SY,Lin CC,Tsan YT,et al.Number of cholangitis episodes as a prognostic marker to predict timing of liver transplantation in biliary atresia patients after Kasai portoenterostomy[J].BMC Pediatr,2018,18(1):119.DOI:10.1186/s12887-018-1074-2.
[21] Du M,Wang J,Tang Y,et al.Evaluation of perioperative complications in the management of biliary atresia[J].Front Pediatr,2020,8:460.DOI:10.3389/fped.2020.00460.
[22] Engel E,Schraml R,Maisch T,et al.Light-induced decomposition of indocyanine green[J].Invest Ophthalmol Vis Sci,2008,49(5):1777-1783.DOI:10.1167/iovs.07-0911.
[23] Nimura H,Narimiya N,Mitsumori N,et al.Infrared ray electronic endoscopy combined with indocyanine green injection for detection of sentinel nodes of patients with gastric cancer[J].Br J Surg,2004,91(5):575-579.DOI:10.1002/bjs.4470.
[24] 姚伟,董岿然.荧光引导技术在儿童肿瘤手术中的应用及展望[J].临床小儿外科杂志,2021,20(10):906-910.DOI:10.12260/lcxewkzz.2021.10.002. Yao W,Dong KR.Applications and future prospects of fluorescence guided surgery for pediatric tumors[J].J Clin Ped Sur,2021,20(10):906-910.DOI:10.12260/lcxewkzz.2021.10.002.
[25] Kwon IG,Son T,Kim HI,et al.Fluorescent lymphography-guided lymphadenectomy during robotic radical gastrectomy for gastric cancer[J].JAMA Surg,2019,154(2):150-158.DOI:10.1001/jamasurg.2018.4267.
[26] Yaseen MA,Yu J,Jung B,et al.Biodistribution of encapsulated indocyanine green in healthy mice[J].Mol Pharm,2009,6(5):1321-1332.DOI:10.1021/mp800270t.
[27] Dolgin SE.Answered and unanswered controversies in the surgical management of extra hepatic biliary atresia[J].Pediatr Transplant,2004,8(6):628-631.DOI:10.1111/j.1399-3046.2004.00243.x.
[28] Lilly JR,Javitt NB.Biliary lipid excretion after hepatic portoenterostomy[J].Ann Surg,1976,184(3):369-375.DOI:10.1097/00000658-197609000-00014.
[29] Castagnetti M,Davenport M,Tizzard S,et al.Hepatobiliary scintigraphy after Kasai procedure for biliary atresia:clinical correlation and prognostic value[J].J Pediatr Surg,2007,42(6):1107-1113.DOI:10.1016/j.jpedsurg.2007.01.063.

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备注/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

更新日期/Last Update: 1900-01-01