吲哚菁绿荧光成像在机器人辅助胰腺手术中预防肝空肠吻合术后胆汁渗漏的应用

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2024-12-01 DOI:10.1016/j.hpb.2024.08.013

Anton F. Gijsen , Roelof P.H. de Vries , Harry G.M. Vaassen , Robert H. Geelkerken , Mike S.L. Liem , Daan J. Lips

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引用次数: 0

摘要

胰腺十二指肠切除术（PD）后因肝空肠吻合术（HJ）不足导致的术后胆汁渗漏（POBL）与高发病率和高死亡率有关。这项队列研究旨在确定 ICG 在机器人微创胰腺手术（R-MIPS）中检测和预防 HJ POBL 的临床意义。研究纳入了2019年至2022年期间所有连续的机器人和ICG辅助HJ吻合术。所有吻合术均由一名外科医生使用达芬奇 X 手术机器人完成。采用近红外技术对胆漏进行客观分析。本研究只考虑与临床相关的 POBL。研究纳入了在2019年至2022年期间接受腹腔镜手术的60名患者。其中 10 例患者的荧光成像显示术中存在肝空肠吻合术不全（HJI）。其中五名患者尽管进行了翻修，但还是出现了POBL，但有五名患者防止了POBL的发生。用 ICG 检测 HJI 预测 POBL 的敏感性和特异性分别为 41.6% 和 89.6%。如果肝管直径小于 5 毫米（相对风险 = 4.68 (p = 0.0345)），或术中检测到 HJI（相对风险 = 3.57 (p = 0.009)），则发生 POBL 的几率明显更高。ICG 是检测术中胆汁渗漏的一种简单而有用的工具。本研究表明，在 R-MIPS 中使用 ICG 进行胆汁照明可预防术后胆漏。

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The use of indocyanine green fluorescence imaging in preventing postoperative bile leakage of the hepaticojejunostomy in robot-assisted pancreatic surgery

Background

Postoperative bile leakage (POBL) due to insufficiency of the hepaticojejunostomy (HJ) after pancreatico-duodenectomy (PD) is associated with high morbidity and mortality. The aim of this cohort study was to determine the clinical relevance of ICG in detecting and preventing POBL of the HJ in robotic minimal invasive pancreatic surgery (R-MIPS).

Methods

All consecutive robot- and ICG-assisted HJ-anastomoses between 2019 and 2022 were included. Biliary leakage was objectified with near infrared technology. Only clinically relevant POBL were considered in this study.

Results

Sixty patients who underwent a PD between 2019 and 2022 were included. In ten patients, fluorescence imaging revealed an intra-operative hepaticojejunostomy insufficiency (HJI). Five of these patients developed POBL despite revision but preventing POBL in five patients. Detection of HJI with ICG predicted POBL with a sensitivity and specificity of 41.6% and 89.6% respectively. There was a significant higher chance of developing a POBL if the hepatic duct diameter was less than 5 mm (relative risk = 4.68 (p = 0.0345)), or if an intra-operative HJI was detected (relative risk = 3.57 (p = 0.009)).

Conclusion

ICG is a simple and useful tool for detecting intra-operative bile leakage. This study shows that bile illumination with ICG in R-MIPS could prevent postoperative bile leakage.

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).