การประยุกต์ใช้สารเรืองแสง ICG ระหว่างการผ่าตัดถุงน้ำดีแบบส่องกล้องเพื่อลดระยะเวลาการนอนโรงพยาบาลหลังการผ่าตัด ในผู้ป่วยที่การผ่าตัดถุงน้ำดีแบบส่องกล้องทำได้ยาก ในโรงพยาบาลพุทธชินราช พิษณุโลก
คำสำคัญ:
laparoscopic cholecystectomy, difficult laparoscopic cholecystectomy, Indocyanine green fluorescence cholangiography, surgical outcomesบทคัดย่อ
Abstract
Background: Laparoscopic cholecystectomy (LC) is currently widely used for the treatment of gallstone disease. In Thailand, studies on the use of ICG to assist LC in patients with difficult LC remain limited. The researchers therefore believe that this study will help clarify the benefits of using indocyanine green (ICG)-assisted laparoscopic cholecystectomy (ICG-FC LC) in patients with difficult LC, and will also serve as a data source for future research development.
Objective: To compare the postoperative length of hospital stay between ICG-FC LC and conventional LC in patients with difficult LC due to biliary stone disease, between January 1, 2020, and December 31, 2025.
Materials and Methods: A cohort observational ambispective study involving patients aged ≥18 years diagnosed with difficult or very difficult LC based on the scoring system of the modified Randhawa’s model by Tongyoo et al., and underwent treatment at Buddhachinaraj Hospital between 2020 and 2025. Surgery was performed by a single surgeon. A total of 168 patients met the eligibility criteria. The first group consisted of patients scheduled for LC (ICG group; n = 84) between January 1, 2025, and December 31, 2025. The second group consisted of patients who underwent LC (non-ICG group; n = 84) between January 1, 2020, and December 31, 2024. Clinical outcomes—including length of hospital stay, drain placement rate, conversion rate, intraoperative blood loss, operative time, and surgery-related complications—were compared. Statistical analyses were performed using Student’s t-test, Chi-square test, Fisher’s exact test, and Poisson regression adjusted for confounders.
Results: The ICG-FC LC group demonstrated a significantly shorter postoperative length of stay compared with the conventional LC group (median 3.6 vs. 4.2 days; adjusted median difference −0.62 days, 95% CI −1.23 to −0.01; p = 0.047). Intraoperative blood loss (18.3 vs. 27.0 mL; p < 0.001) and operative time (99.0 vs. 114.0 minutes; p < 0.001) were also significantly lower in the ICG group. Drain placement rate, conversion rates, and complication rates were comparable between groups. Among patients with difficult LC, ICG-FC LC resulted in a significantly shorter length of stay (1.3 vs. 1.9 days; adjusted median difference −0.6 days, 95% CI −0.9 to −0.3; p < 0.001) and reduced intraoperative blood loss (9.9 vs. 25.1 mL; p < 0.001). In very difficult LC cases, no statistically significant differences were observed, although a trend toward shorter length of stay was noted in the ICG group (2.0 vs 3.4 days, p = 0.125).
Conclusion: ICG-FC LC was associated with a shorter postoperative length of stay and reduced intraoperative blood loss while maintaining comparable conversion rates and postoperative complications relative to conventional LC. These findings support the use of ICG fluorescence cholangiography as a safe and beneficial adjunct in selected difficult LC procedures.
Keywords: laparoscopic cholecystectomy, difficult laparoscopic cholecystectomy, Indocyanine green fluorescence cholangiography, surgical outcomes
เอกสารอ้างอิง
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