Abstract：
BACKGROUND: The partial cholecystectomy may be performed while in complicated laparoscopic cholecystectomy (LC). Biliary anomalies especially the accessory bile duct are established high risk of bile duct injury (BDI) in LC. Laparoscopic resection of residual gallbladder is a challenging procedure and extremely vulnerable to BDI. We report the execution of a laparoscopic resection of residual gallbladder with a communicating accessory bile duct using indocyanine green (ICG) fluorescence cholangiography and the intraoperative cholangiography (IOC). A case that has not been reported previously.
METHODS: A 29-year-old female with history of laparoscopic partial cholecystectomy was admitted in our hospital. Magnetic resonance cholangiopancreatography (MRCP) revealed the residual gallbladder with an accessory bile duct. Considering the complexity of this patient, we performed a laparoscopic surgery using ICG fluorescence cholangiography. ICG was injected intravenously 1 h before the surgery, the residual gallbladder and the extrahepatic biliary structures including the accessory bile duct were imaged in green in fluorescence imaging that could be recognized clearly. IOC revealed that residual gallbladder communicated with intrahepatic bile duct through the accessory bile duct and drained into the common bile duct (CBD). The entire procedure was performed smoothly and successfully without bile duct injuries.
CONCLUSIONS: Laparoscopic resection of residual gallbladder is a challenging procedure. Fluorescence cholangiography using ICG is regarded as a novel technique that could provide a real-time imaging intraoperative, which allowed to recognize and identify the residual gallbladder and the extrahepatic bile duct. IOC is also important in identifying a communicating accessory bile duct. Under the guidance of them, we completed this laparoscopic surgery.
CONCLUSIONS: The combination of fluorescence cholangiography using ICG and IOC have profound significance in complicated LC.
METHODS: A 29-year-old female with history of laparoscopic partial cholecystectomy was admitted in our hospital. Magnetic resonance cholangiopancreatography (MRCP) revealed the residual gallbladder with an accessory bile duct. Considering the complexity of this patient, we performed a laparoscopic surgery using ICG fluorescence cholangiography. ICG was injected intravenously 1 h before the surgery, the residual gallbladder and the extrahepatic biliary structures including the accessory bile duct were imaged in green in fluorescence imaging that could be recognized clearly. IOC revealed that residual gallbladder communicated with intrahepatic bile duct through the accessory bile duct and drained into the common bile duct (CBD). The entire procedure was performed smoothly and successfully without bile duct injuries.
CONCLUSIONS: Laparoscopic resection of residual gallbladder is a challenging procedure. Fluorescence cholangiography using ICG is regarded as a novel technique that could provide a real-time imaging intraoperative, which allowed to recognize and identify the residual gallbladder and the extrahepatic bile duct. IOC is also important in identifying a communicating accessory bile duct. Under the guidance of them, we completed this laparoscopic surgery.
CONCLUSIONS: The combination of fluorescence cholangiography using ICG and IOC have profound significance in complicated LC.
摘要：
背景：在复杂的腹腔镜胆囊切除术（LC）中可以进行部分胆囊切除术。在LC中，胆道异常尤其是副胆管是胆管损伤（BDI）的高风险。腹腔镜切除残余胆囊是一项具有挑战性的手术，极易受到BDI的影响。我们报告了使用吲哚菁绿（ICG）荧光胆道造影和术中胆道造影（IOC）对带有连通辅助胆管的残余胆囊进行腹腔镜切除术的情况。以前没有报告过的病例。
方法：我院收治一名29岁女性，有腹腔镜胆囊部分切除术史。磁共振胰胆管造影（MRCP）显示残留的胆囊带有辅助胆管。考虑到这个病人的复杂性,我们使用ICG荧光胆管造影进行了腹腔镜手术.手术前1h静脉注射ICG，残余胆囊和肝外胆管结构包括副胆管在荧光成像中以绿色成像，可以清楚地识别。IOC显示，残余胆囊通过副胆管与肝内胆管连通，并排入胆总管（CBD）。整个过程顺利，成功地进行，没有胆管损伤。
结论：腹腔镜切除残余胆囊是一项具有挑战性的手术。使用ICG的荧光胆道造影被认为是一种新颖的技术，可以提供实时成像术中，这允许识别和识别残余的胆囊和肝外胆管。IOC对于识别交通辅助胆管也很重要。在他们的指导下,我们完成了这个腹腔镜手术.
结论：使用ICG和IOC联合进行荧光胆管造影在复杂LC中具有深远的意义。
方法：我院收治一名29岁女性，有腹腔镜胆囊部分切除术史。磁共振胰胆管造影（MRCP）显示残留的胆囊带有辅助胆管。考虑到这个病人的复杂性,我们使用ICG荧光胆管造影进行了腹腔镜手术.手术前1h静脉注射ICG，残余胆囊和肝外胆管结构包括副胆管在荧光成像中以绿色成像，可以清楚地识别。IOC显示，残余胆囊通过副胆管与肝内胆管连通，并排入胆总管（CBD）。整个过程顺利，成功地进行，没有胆管损伤。
结论：腹腔镜切除残余胆囊是一项具有挑战性的手术。使用ICG的荧光胆道造影被认为是一种新颖的技术，可以提供实时成像术中，这允许识别和识别残余的胆囊和肝外胆管。IOC对于识别交通辅助胆管也很重要。在他们的指导下,我们完成了这个腹腔镜手术.
结论：使用ICG和IOC联合进行荧光胆管造影在复杂LC中具有深远的意义。
