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Интраоперационная визуализация желчных протоков с помощью индоцианина зеленого при лапароскопической холецистэктомии

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Цель. Оценка возможности ранней идентификации желчных протоков с применением света в ближнем инфракрасном диапазоне и флюоресцентного агента индоцианина зеленого при лапароскопической холецистэктомии у пациентов с повышенным риском повреждения желчных протоков. Материал и методы. Лапароскопическая холецистэктомия выполнена 16 пациентам с различными факторами риска травмы желчных протоков. Для интраоперационного определения топографии желчных протоков применяли систему флюоресцентной диагностики. Результаты. Применение интраоперационной диагностики в ряде наблюдений облегчило идентификацию трубчатых структур в проекции треугольника Кало и позволило избежать конверсии. Заключение. Первый опыт интраоперационного обнаружения желчных протоков с помощью индоцианина зеленого при лапароскопической холецистэктомии свидетельствует о том, что метод может стать важной дополнительной процедурой у пациентов с повышенным риском повреждения желчных протоков. Необходимы дальнейшие исследования для оптимизации методов, определения дозы, времени и критериев отбора пациентов.

Ключевые слова:
печень, желчный пузырь, желчные протоки, лапароскопическая холецистэктомия, индоцианин зеленый, флюоресцентная диагностика, повреждение желчных протоков, liver, gall bladder, bile duct, laparoscopic cholecystectomy, indocyanine green, fluorescent imaging, bile duct injury

Литература:
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Fluorescent imaging with indocyanine green for intraoperative bilie ducts examination during laparoscopic cholecystectomy

Aim. Assessment of the capability of early identification of the bile ducts using near infrared light and fluorescent agent indocyanine green in laparoscopic cholecystectomy in patients with an increased risk of bile duct injury. Methods. Laparoscopic cholecystectomy using fluorescent imaging system was performed in 16 patients with different risk factors for bile duct injury. Results. The use of intraoperative imaging in a number of cases facilitated the identification of tubular structures in the Calot triangle and allowed to avoid the conversion. Conclusion. The first experience of intraoperative imaging of bile ducts using indocyanine green in laparoscopic cholecystectomy indicate that this method can become an important additional diagnostic procedure in patients with an increased risk of bile duct injury. Further research is needed to optimize methods, dosage, time and patient selection criteria.

Keywords:
печень, желчный пузырь, желчные протоки, лапароскопическая холецистэктомия, индоцианин зеленый, флюоресцентная диагностика, повреждение желчных протоков, liver, gall bladder, bile duct, laparoscopic cholecystectomy, indocyanine green, fluorescent imaging, bile duct injury