摘要
Abstract
Objective To investigate the clinical efficacy of indocyanine green(ICG)fluorescenceguided laparoscopic cholecystectomy(LC)for acute cholecystitis(AC)and analyze factors associated with postoperative complications(PCs).Methods A retrospective analysis was conducted on 279 AC patients who underwent LC(September 2020 to September 2024).Among them,179 underwent ICG fluorescence guided LC(fluorescence group)and were subdivided by injection timing/dose:group A(47 cases,15 min,2.5 mg),group B(45 cases,30 min,2.5 mg),group C(48 cases,30 min,5.0 mg),and group D(39 cases,60 min,5.0 mg)to assess biliary visualization.Concurrently,100 patients underwent conventional LC(white light group).Perioperative indicators,liver function,and 3-month PCs were compared.Multivariate Logistic regression and a decision tree model identified risk factors for PCs.Results Liver fluorescence intensity was highest in group A(P<0.05).The cystic duct-to-liver fluorescence contrast ratio was highest in group B(P<0.05).The fluorescence group showed shorter Calot triangle dissection time,operative time,postoperative hospital stay,and less intraoperative blood than the white light group(all P<0.05).Multivariate Logistic regression identified independent risk factors for PCs:body mass index(BMI)≥25 kg/m2((OR)=3.534,95％CI:1.057～11.811),onset-to-surgery time≥72 h((OR)=3.208,95％CI:1.227～8.390),anatomical variation of Calot's triangle((OR)=2.870,95％CI:1.085～7.590),gallbladder wall thickness≥5 mm((OR)=2.957,95％CI:1.147～7.625),and American Society of Anesthesiologists(ASA)grade Ⅲ～Ⅳ((OR)=3.179,95％CI:1.245～8.118)(all P<0.05).Surgeon experience≥5 years was a protective factor((OR)=0.280,95％CI:0.081～0.970,P<0.05).The decision tree model(accuracy 91.40％)identified surgeon experience as the most important predictor.Conclusion Preoperative ICG injection(2.5 mg,30 min)provides optimal fluorescence imaging.ICG-guided LC is safe and effective for AC,reducing operative time,blood loss,and hospital stay.Independent risk factors for PCs include BMI≥25 kg/m²,onset-to-surgery time≥72 h,anatomical variation of Calot's triangle,gallbladder wall thickness≥5 mm,and high ASA grade Ⅲ～Ⅳ;Surgeon experience≥5 years is protective.Preoperative thorough evaluation is essential to reduce the risk of postoperative complications.关键词
吲哚菁绿(ICG)/腹腔镜胆囊切除术(LC)/急性胆囊炎/术后并发症/相关因素Key words
indocyanine green(ICG)/laparoscopic cholecystectomy(LC)/acute cholecystitis/postoperative complications/relevant factor分类
医药卫生
