1.Department of General Surgery, People's Hospital of Liangjiang New Area, Chongqing 401121, China;2.Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Kunming Medical University, Kunming 650032, China
Background and Aims Mirizzi syndrome (MS) is a rare complication of cholecystitis and chronic cholelithiasis. With the development of minimally invasive techniques, laparoscopic cholecystectomy (LC) is increasingly being used for the treatment of type I MS, in which, the intraoperative biliary tract injury is still the most serious complication. At present, indocyanine green (ICG) fluorescent navigation technique is more and more widely being used in the clinical practice of laparoscopic hepatobiliary surgery. This technique can well display the drainage area of the hepatic portal vein and play an important role in anatomical liver resection. During metabolism, ICG is taken up by hepatocytes and excreted into bile and thereby delivered into the duodenum through the biliary tract, which can guide and trace the anatomical structure of the entire biliary tract system. Therefore, this study was performed to investigate the efficacy of ICG in identification and navigation of biliary tract during LC for type I MS.Methods The clinical data of 67 patients with type I MS undergoing LC in the Second Affiliated Hospital of Kunming Medical University from October 2019 to January 2022 were retrospectively analyzed. Of the patients, 35 cases underwent LC under the guidance of intraoperative fluorescence navigation using ICG (fluorescence navigation group), and 32 cases underwent conventional LC (conventional surgery group). The main clinical variables were compared between the two groups of patients.Results There were no significant differences in preoperative data and laboratory measurements between the two groups of patients (all P>0.05). In fluorescence navigation group compared with conventional surgery group, the mean operative time (74.66 min vs. 93.03 min), mean intraoperative blood loss (20.43 mL vs. 57.34 mL) and open conversion rate (0 vs. 12.5%) were significantly reduced; the average drainage volume on postoperative day 1 （25.43 mL vs. 36.63 mL）, average time to tube removal (1.29 d vs. 1.91 d), average length of postoperative hospital stay (2.8 d vs. 3.66 d) and average total hospitalization cost (11 349.43 yuan vs. 12 907.41 yuan) were significantly decreased (all P<0.05). After operation, abdominal wound infection occurred in 2 cases in fluorescence navigation group, while biliary tract injury occurred in 2 cases, bile leakage occurred in 2 cases, and abdominal wound infection occurred in 4 cases in conventional surgery group. The overall incidence rate of postoperative complications in fluorescence navigation group was significantly lower than that in conventional surgery group (5.7% vs. 25.0%, P=0.039).Conclusion ICG fluorescent navigation can display biliary tract system in real time, reduce intraoperative bleeding, operative time, conversion to open surgery and incidence of complications, and prevent biliary tract injury.
WANG Yunfeng, CUN Dongyun, HUANG Jie, TIAN Daguang. Application of indocyanine green fluorescent navigation in laparoscopic cholecystectomy for type I Mirizzi syndrome[J]. Chin J Gen Surg,2022,31(8):1031-1038.