腹腔镜胆囊切除术(Laparoscopic Cholecystectomy,LC)作为一种常规的微创手术,进入临床实践不久便迅速成为胆囊切除术的标准手术方式。
《胆囊切除术中预防胆管损伤多协会共识和实践指南(2020)》对于此类患者(急性胆囊炎、胆囊颈部结石、胆道变异等)建议LC术中行胆道造影以降低胆管损伤的风险。
近年,吲哚菁绿(Indocyanine Green,ICG)荧光胆道造影作为术中识别胆道解剖的新方法,已广泛应用于多个医学领域[1-2]。ICG荧光胆道造影技术可无创地显示肝外胆道并提示胆漏,实时反映术中情况,预防胆道损伤的发生[3]。
胆囊手术中利用荧光导航技术,可以实现对胆总管及胆囊管的定位显影,有助于肝外胆道系统的可视化,从而避免术中因炎症、解剖变异等因素造成的显示不清,进而防止医源性胆道损伤的发生,以免给患者及其家庭带来严重后果。
术前事先准备好剂量为2mL 2.5mg/mL ICG溶液。全麻成功后,患者取平卧位常规消毒铺巾,后取头高脚低左倾位建立气腹。
Fursight™ 超声软组织手术设备是远赛医疗完全自主研发产品:
具备自主知识产权的组织自适应加强技术(Adaptive Reinforce Technology)
智能频率追踪技术,提升切凝效率,大大降低热损伤
自动智能学习功能,加快第一道锁频,频率更精确、切凝更快速
卓越的组织切割能力
强大的血管凝闭能力
更小的热损伤
高品质材料工艺
人体工学设计
参考文献:
[1] 张正伟,陈晓宁,孙世波.吲哚菁绿标记荧光腹腔镜胃癌手术的进展与不足[J].腹腔镜外科杂志,2021,26(1):77-80.
[2] 王子函,冈天然,武珊珊,等.吲哚菁绿分子荧光影像技术在乳腺癌单孔法腔镜前哨淋巴结活检术中的应用[J].腹腔镜外科杂志,2021,26(5):326-330.
[3] Broderick RC,Lee AM,Cheverie JN,et al.Fluorescent cholangiography significantly improves patient outcomes for laparoscopic cholecystectomy[J].Surg Endosc,2021,35(10):5729-5739.
[4] Dip F,Roy M,Menzo EL,et al.Routine use of fluorescent incisionless cholangiography as a new imaging modality during laparoscopic cholecystectomy[J].Surg Endosc,2015,29(6):1621-1626.
[5] Liu YY,Liao CH,Diana M,et al.Near-infrared cholecystocholangiography with direct intragallbladder indocyanine green injection:preliminary clinical results[J].Surg Endosc,2018,32(3):1506-1514.
[6] Ishizawa T,Bandai Y,Kokudo N.Fluorescent cholangiography using indocyanine green for laparoscopic cholecystectomy:an initial experience[J].Arch Surg,2009,144(4):381-382.
[7] 倪忠鹏,张昕辉,刘养岁.吲哚菁绿荧光染色技术在腹腔镜胆囊切除术中的价值分析[J].腹部外科,2020,33(3):212-217.
[8] Daskalaki D,Fernandes E,Wang X,et al.Indocyanine green(ICG)fluorescent cholangiography during robotic cholecystectomy:results of 184 consecutive cases in a single institution[J].Surg Innov,2014,21(6):615-621.
[9] Papaconstantinou HT,Thomas JS.Single-incision laparoscopic colectomy for cancer:assessment of oncologic resection and short-term outcomes in a case-matched comparison with standard laparoscopy[J].Surgery,2011,150(4):820-827.
[10] Champagne BJ,Papaconstantinou HT,Parmar SS,et al.Single-incision versus standard multiport laparoscopic colectomy:a multicenter,case-controlled comparison[J].Ann Surg,2012,255(1):66-69.
[11] Poon JT,Cheung CW,Fan JK,et al.Single-incision versus conventional laparoscopic colectomy for colonic neoplasm:a randomized,controlled trial[J].Surg Endosc,2012,26(10):2729-2734.
[12] Takemasa I,Uemura M,Nishimura J,et al.Feasibility of single-site laparoscopic colectomy with complete mesocolic excision for colon cancer:a prospective case-control comparison[J].Surg Endosc,2014,28(4):1110-1118.
[13] 滕文浩,臧卫东,魏丞,等.单孔加一腹腔镜技术在胃肠手术中的应用现状与展望[J].腹腔镜外科杂志,2020,25(1):4-8.
[14] 中国医师协会微无创专业委员会外科单孔学组.单孔加一腹腔镜胃癌手术操作专家共识(2020版)[S].腹腔镜外科杂志,2021,26(1):7-12.
[15]王潇宁,吴硕东,吴晓东.吲哚菁绿荧光胆道造影在腹腔镜胆囊切除术中的即时应用体会[J].腹腔镜外科杂志,2021,26(11):851-857.