吲哚菁绿荧光导航在单孔腹腔镜胆囊切除术中的临床应用价值

Clinical value of indocyanine green fluorescence navigation in single-incision laparoscopic cholecystectomy

摘要:

背景与目的 单孔腹腔镜胆囊切除术（LC）因其创伤小、美容效果佳而日益普及，但在胆管辨识及操作空间方面仍具挑战。吲哚菁绿（ICG）荧光导航能够实时显影胆管，有望提高手术的安全性与效率。本研究旨在评估ICG荧光导航在单孔LC中的临床应用价值。方法 回顾性分析2023年1月—2024年12月在江苏大学附属宜兴医院接受择期单孔LC的59例胆囊良性疾病患者，根据是否使用ICG荧光导航分为荧光组（n=27）和白光组（n=32）。比较两组在胆囊三角解剖时间、手术时间、术中出血量、术者满意度、住院时间及并发症方面的差异。结果 两组患者一般临床特征差异无统计学意义（均P>0.05）。荧光组患者的胆囊管、肝总管和胆总管均成功显影。与白光组比较，荧光组的胆囊三角解剖时间［（25.56±3.49）min vs.（38.81±5.59）min］、手术时间［（44.67±3.06）min vs.（61.31±4.96）min］及术中出血量［（13.44±1.70）mL vs.（14.50±2.11）mL］均明显减少（均P<0.05），且术者满意度明显更高（P<0.05）。两组均未出现术中胆管损伤、中转为三孔手术或术后发生并发症。结论 ICG荧光导航可显著提高单孔LC中胆管辨识效率，缩短手术时间，减少出血，并改善术者满意度，具有良好的临床应用前景。

Abstract:

Background and Aims Single-incision laparoscopic cholecystectomy (LC) has become increasingly popular due to its minimal invasiveness and cosmetic advantages, but challenges remain in biliary identification and limited operative space. Indocyanine green (ICG) fluorescence navigation enables real-time visualization of the biliary tract and may enhance surgical safety and efficiency. This study aimed to evaluate the clinical application value of ICG fluorescence navigation in single-incision LC.Methods A retrospective analysis was conducted on 59 patients with benign gallbladder diseases who underwent elective single-incision LC at Yixing Hospital affiliated to Jiangsu University from January 2023 to December 2024. Patients were divided into a fluorescence group (n=27) and a white-light group (n=32) according to whether ICG fluorescence navigation was applied. The two groups were compared in terms of Calot's triangle dissection time, operative time, intraoperative blood loss, surgeon satisfaction, hospital stay, and postoperative complications.Results No significant differences were observed in baseline clinical characteristics between the two groups (all P>0.05). In the fluorescence group, the cystic duct, common hepatic duct, and common bile duct were all successfully visualized. Compared with the white-light group, the fluorescence group had significantly shorter Calot's triangle dissection time [(25.56±3.49) min vs. (38.81±5.59) min], shorter operative time [(44.67±3.06) min vs. (61.31±4.96) min], and less intraoperative blood loss [(13.44±1.70) mL vs. (14.50±2.11) mL] (all P<0.05), with significantly higher surgeon satisfaction (P<0.05). No intraoperative bile duct injury, conversion to three-port surgery, or postoperative complications occurred in either group.Conclusion ICG fluorescence navigation can significantly improve biliary identification efficiency in single-incision LC, shorten operative time, reduce blood loss, and enhance surgeon satisfaction, demonstrating promising clinical application prospects.