探讨经胆囊注射ICG荧光胆道造影在胆囊结石合并胆囊炎患者腹腔镜胆囊切除术（LC）中的应用价值。

回顾性分析2020年9月至2022年2月在昆明医科大学第二附属医院行LC的60例胆囊结石合并胆囊炎患者临床资料。其中男31例，女29例；年龄22~70岁，中位年龄50岁。患者均签署知情同意书，符合医学伦理学规定。根据LC术中是否应用ICG荧光胆道造影将患者分为ICG组（30例）及对照组（30例）。观察患者围手术期情况。两组肝外胆管识别率等比较采用χ²检验，手术时间等比较采用t检验，术中出血量比较采用Mann-Whitney U检验。

两组均成功实施手术，无围手术期死亡。ICG组胆囊管、胆总管识别率分别为77%（23/30）、87%（26/30），明显高于对照组的27%（8/30）、33%（10/30） （χ²=15.017，17.778；P<0.05）。ICG组平均解剖胆囊三角时间、分离胆囊床时间、手术时间分别为（8.4±2.5）、（10.9±3.4）、（49.8±9.9）min，明显短于对照组的（10.6±3.5）、（15.7±5.5）、（57.9±13.6）min（t=-2.769，-3.973，-2.655；P<0.05）。ICG组术中出血量中位数为15（6）ml，明显少于对照组的23（11）ml（Z=-4.172，P<0.05）。ICG组无肝外胆管损伤及术中中转开腹，对照组术中中转开腹1例，胆总管损伤2例，对症处理，术后1个月随访均正常。

对于胆囊结石合并胆囊炎患者，术中经胆囊注射ICG荧光胆道造影在LC中可有效辨别胆囊管及胆总管，避免术中医源性胆管损伤，减少手术时间及术中出血。

To evaluate the application value of fluorescent cholangiography via gallbladder injection of ICG in laparoscopic cholecystectomy (LC) for patients with gallstones and cholecystitis.

Clinical data of 60 patients with gallstones and cholecystitis who underwent LC in the Second Affiliated Hospital of Kunming Medical University from September 2020 to February 2022 were retrospectively analyzed. Among them, 31 patients were male and 29 female, aged from 22 to 70 years, with a median age of 50 years. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were divided into the ICG group (n=30) and control group (n=30) according to whether ICG fluorescent cholangiography was applied during LC. Perioperative conditions of all patients were observed. The identification rate of extrahepatic bile duct between two groups was compared by Chi-square test. The operation time between two groups was compared by t test. Intraoperative blood loss between two groups was compared by Mann-Whitney U test.

The surgeries were successfully performed in both groups, and no perioperative death occurred. The identification rates of cystic duct and common bile duct in the ICG group were 77%(23/30) and 87%(26/30), significantly higher than 27%(8/30) and 33%(10/30) in the control group (χ²=15.017, 17.778; P<0.05). In the ICG group, the average time of dissecting Calot's triangle, separating gallbladder bed and operation time were (8.4±2.5), (10.9±3.4) and (49.8±9.9) min, significantly shorter than (10.6±3.5), (15.7±5.5) and (57.9±13.6) min in the control group (t=-2.769, -3.973, -2.655; P<0.05). The median intraoperative blood loss in the ICG group was 15(6) ml, significantly less than 23(11) ml in the control group (Z=-4.172, P<0.05). In the ICG group, no extrahepatic bile duct injury and conversion to open surgery were reported, whereas there was one case of conversion to open surgery and 2 cases of common bile duct injury in the control group, who were treated symptomatic treatments, and all cases were restored to normal in postoperative 1-month follow-up.

For patients with gallstones and cholecystitis, fluorescent cholangiography via gallbladder injection of ICG during LC can accurately identify cystic duct from common bile duct, effectively avoid intraoperative iatrogenic bile duct injury, shorten the operation time and reduce the intraoperative blood loss.