急性胆囊炎（Grade Ⅱ）腹腔镜手术中应用荧光即时成像技术——吲哚氰绿最佳使用剂量探讨

doi:10.3969/j.issn.1009-976X.2025.06.003

摘要/Abstract

摘要： 目的探讨LC术中经静脉注射吲哚菁绿（ICG）的最佳剂量。方法选取2024年1月至2024年12月在普宁市人民医院普外科拟行荧光导航LC的80例患者作为研究对象,采用分配隐藏的随机信封法分为四组,每组20例。各组术中分别静脉注射不同剂量ICG：0.125 mg、0.25 mg、0.5 mg和5 mg。观察四组患者的肝外胆管显影时间、显影率及肝脏和胆管的荧光强度,并计算胆管与肝脏的荧光强度比值（胆管肝脏比,BLR）,以评估胆管造影效果。结果 0.5 mg组表现出更好的显影率,四组患者显影率差异有统计学意义（P=0.01）;四组患者胆总管显影时间差异无统计学意义（P=0.162）。在BLR≥1、BLR≥1.5、BLR≥2及BLR≥2.5四个BLR分层标准下,0.5 mg组的合格病例数均为四组中最高,四组间整体差异均有统计学意义（均P<0.05）。结论 LC术中静脉注射0.5 mg ICG,对肝外胆道荧光显影效果更佳。

关键词: 急性胆囊炎, 荧光胆道造影, 吲哚菁绿, 腹腔镜胆囊切除术

Abstract: Objective To investigate the optimal intravenous dosage of indocyanine green （ICG） during laparoscopic cholecystectomy （LC）. Methods Eighty patients scheduled for fluorescence-guided laparoscopic cholecystectomy （LC） in the Department of General Surgery, Puning People's Hospital, from January 2024 to December 2024 were enrolled as research subjects. They were randomly divided into four groups with 20 cases each using the envelope method. Different doses of indocyanine green （ICG） were intravenously injected intraoperatively in each group： 0.125 mg, 0.25 mg, 0.5 mg, and 5 mg. The extrahepatic bile duct visualization time, visualization rate, and fluorescence intensity of the liver and bile duct were observed in the four groups. Additionally, the fluorescence intensity ratio between the two （bile duct-to-liver ratio, BLR） was analyzed to evaluate the effect of cholangiography. Results The 0.5 mg group exhibited a superior visualization rate, with a statistically significant difference among the four groups （P=0.01）. There was no statistically significant difference in the common bile duct visualization time across the four groups （P=0.162）. For the stratified analysis of the bile duct-to-liver ratio （BLR）, we counted the number of eligible cases with BLR≥1, BLR≥1.5, BLR≥2, and BLR≥2.5, respectively. The results showed that under the above four BLR stratification criteria, the number of eligible cases in the 0.5 mg group was the highest among the four groups, and there were statistically significant overall differences among the four groups （all P<0.05）. Conclusion Intravenous injection of 0.5 mg ICG during LC provides optimal fluorescence imaging for the extrahepatic biliary tract.

Key words: acute cholecystitis, fluorescence cholangiography, indocyanine green, laparoscopic cholecystectomy

中图分类号:

R657.4

陈洽铭, 李镇潘, 黄丹娜, 张卓敏, 王利勇, 姚乐钊, 郑重. 急性胆囊炎（Grade Ⅱ）腹腔镜手术中应用荧光即时成像技术——吲哚氰绿最佳使用剂量探讨[J]. 岭南现代临床外科, 2025, 25(06): 360-366.

CHEN Qia-ming, LI Zhen-pan, HUANG Dan-na, ZHANG Zhuo-min, WANG Li-yong, YAO Le-zhao, ZHENG Zhong. Exploring the optimal dosage of indocyanine green in real-time fluorescence imaging during laparoscopic surgery for acute cholecystitis （Grade Ⅱ）[J]. Lingnan Modern Clinics In Surgery, 2025, 25(06): 360-366.

参考文献

[1] Coelho JCU, Costa MAR da, Enne M, et al. Acute Cholecystitis in High-Risk Patients. Surgical, Radiological, or Endoscopic Treatment? Brazilian College of Digestive Surgery Position Paper[J]. Arq Bras Cir Dig (São Paulo), 2023, 36(4): e1461.
[2] 何飞, 周明, 管思强. 急性胆囊炎腹腔镜胆囊切除术后并发症危险因素与风险预测模型的构建[J]. 中国现代普通外科进展, 2024, 31(9): 709-713.
[3] Inoue K, Ueno T, Douchi D, et al.Risk Factors for Difficulty of Laparoscopic Cholecystectomy in Grade II Acute Cholecystitis According to the Tokyo Guidelines 2013[J]. BMC Surg, 2017, 17(1): 123.
[4] Pesce A, Fabbri N, Bonazza L, et al.The role of fluorescent cholangiography to improve operative safety in different severity degrees of acute cholecystitis during emergency laparoscopic cholecystectomy: a prospective cohort study[J]. Int J Surg, 2024, 110(12): 7775-7781.
[5] Paul S, Khataniar H, Ck A, et al.Preoperative scoring system validation and analysis of associated risk factors in predicting difficult laparoscopic cholecystectomy in patients with acute calculous cholecystitis: A prospective observational study[J]. Turk J Surg, 2022, 38(4): 375-381.
[6] Zhang L, Liu X, Zou B, et al.The Role of Indocyanine Green Fluorescence in Complex Laparoscopic Cholecystectomy Navigation[J]. J Vis Exp , 2025, 215: e65897.
[7] 黄晓强, 黄志强. 腹腔镜胆囊切除术的并发症 (附 39238 例分析)[J]. 中华外科杂志, 1997, 35(11): 655-657.
[8] Cassinotti E, Al-Taher M, Antoniou SA, et al.European Association for Endoscopic Surgery (EAES) consensus on Indocyanine Green (ICG) fluorescence-guided surgery[J]. Surg Endosc, 2023, 37(3): 1629-1648.
[9] Liu D, Wang Y, Xue F, et al.Comparative analysis of indocyanine green dosages for optimal fluorescence imaging in laparoscopic cholecystectomy[J]. Sci Rep, 2025, 15(1): 13491.
[10] Symeonidis S, Mantzoros I, Anestiadou E, et al.Biliary Anatomy Visualization and Surgeon Satisfaction Using Standard Cholangiography versus Indocyanine Green Fluorescent Cholangiography during Elective Laparoscopic Cholecystectomy: A Randomized Controlled Trial[J]. J Clin Med, 2024, 13(3): 864.
[11] Campaña AM, Farre-Alins P, Gracia-Roman R, et al.INDURG TRIAL Protocol: A Randomized Controlled Trial Using Indocyanine Green during Cholecystectomy in Acute Cholecystitis[J]. Dig Surg, 2024, 41(3): 141-146.
[12] Bos JVD, Schols RM, Kuijk SMJV, et al.Technical Note: Are Currently Used Measurements of Fluorescence Intensity in Near Infrared Fluorescence Imaging During Laparoscopic Cholecystectomy Comparable[J]. J Laparoendosc Adv Surg Tech A, 2019, 29(12): 1549-1555.
[13] Osayi SN, Wendling MR, Drosdeck JM, et al.Near-infrared fluorescent cholangiography facilitates identification of biliary anatomy during laparoscopic cholecystectomy[J]. Surg Endosc, 2015, 29(2): 368-375.
[14] 王潇宁, 吴硕东, 汪聪, 等. LC 术中经静脉注射吲哚菁绿最佳给药剂量的探讨[J]. 肝胆胰外科杂志, 2022, 34(1): 1-11.
[15] Huang Y, Chen Q, Kuang J, et al.Real-time fluorescent cholangiography with indocyanine green in laparoscopic cholecystectomy: a randomized controlled trial to establish the optimal indocyanine green dose within 30 min preoperatively[J]. Surg Today, 2023, 53(2): 223-231.
[16] Boogerd LSF, Handgraaf HJM, Huurman VAL, et al.The Best Approach for Laparoscopic Fluorescence Cholangiography: Overview of the Literature and Optimization of Dose and Dosing Time[J]. Surg Innov, 2017, 24(4): 386-396.
[17] Tsutsui N, Yoshida M, Nakagawa H, et al.Optimal timing of preoperative indocyanine green administration for fluorescent cholangiography during laparoscopic cholecystectomy using the PINPOINT? Endoscopic Fluorescence Imaging System[J]. Asian J Endosc Surg, 2018, 11(3): 199-205.
[18] Verbeek FPR, Schaafsma BE, Tummers QRJG, et al.Optimization of near-infrared fluorescence cholangiography for open and laparoscopic surgery[J]. Surg Endosc, 2014, 28(4): 1076-1082.