PDF(Pubmed)
Abstract：
UNASSIGNED: Iatrogenic ureteral injury is a severe surgical complication, with a highest incidence of 1.5% in gynecological surgeries. The purpose of this report is to document our initial experience with using methylene blue (MB) to label the ureter in gynecological laparoscopic surgeries and to explore its effectiveness and safety. This is also a novel description of simultaneously visualizing ureteral MB fluorescence and sentinel lymph nodes (SLN\'s) Indocyanine Green (ICG) fluorescence using the same camera.
UNASSIGNED: This study included patients undergoing gynecological laparoscopic surgeries, with the same surgeon performing all cases. During the early stages of each surgery, rapid intravenous infusion of MB was administered. For cases requiring SLN imaging, we also injected ICG solution into the cervix. Assessment of the included cases was conducted both intraoperatively and postoperatively. The group that had MB fluorescence (Group A) was compared to a control group that did not have it (Group B).
UNASSIGNED: A total of 25 patients (Group A) received MB during surgery, demonstrating 45 ureters clearly, with an imaging success rate of 90%. Continuous and clearer fluorescence imaging was achieved in cases with ureteral hydronephrosis. In most patients, ureteral fluorescence was visible 15-20 min after intravenous infusion of MB, and 64% still exhibited fluorescence at the end of the surgery. In patients who had both ICG and MB, dual fluorescence imaging was achieved clearly. Among the included cases, there were no iatrogenic ureteral injuries (0%), which we observed to be lower than in patients who did not receive MB (1.3%). The rate of adverse events was similar in both groups.
UNASSIGNED: Using MB fluorescence is an effective and safe method of visualizing the ureters during gynecological surgeries, and can diminish iatrogenic ureteral injury without increased associated adverse events. It therefore may offer promising prospects for clinical application.
UNASSIGNED: This study included patients undergoing gynecological laparoscopic surgeries, with the same surgeon performing all cases. During the early stages of each surgery, rapid intravenous infusion of MB was administered. For cases requiring SLN imaging, we also injected ICG solution into the cervix. Assessment of the included cases was conducted both intraoperatively and postoperatively. The group that had MB fluorescence (Group A) was compared to a control group that did not have it (Group B).
UNASSIGNED: A total of 25 patients (Group A) received MB during surgery, demonstrating 45 ureters clearly, with an imaging success rate of 90%. Continuous and clearer fluorescence imaging was achieved in cases with ureteral hydronephrosis. In most patients, ureteral fluorescence was visible 15-20 min after intravenous infusion of MB, and 64% still exhibited fluorescence at the end of the surgery. In patients who had both ICG and MB, dual fluorescence imaging was achieved clearly. Among the included cases, there were no iatrogenic ureteral injuries (0%), which we observed to be lower than in patients who did not receive MB (1.3%). The rate of adverse events was similar in both groups.
UNASSIGNED: Using MB fluorescence is an effective and safe method of visualizing the ureters during gynecological surgeries, and can diminish iatrogenic ureteral injury without increased associated adverse events. It therefore may offer promising prospects for clinical application.
摘要：
■医源性输尿管损伤是一种严重的手术并发症，妇科手术发病率最高，为1.5%。本报告的目的是记录我们在妇科腹腔镜手术中使用亚甲蓝（MB）标记输尿管的初步经验，并探讨其有效性和安全性。这也是使用同一相机同时可视化输尿管MB荧光和前哨淋巴结（SLN）吲哚菁绿（ICG）荧光的新颖描述。
■这项研究包括接受妇科腹腔镜手术的患者，同一位外科医生进行所有病例。在每次手术的早期阶段，快速静脉输注MB.对于需要SLN成像的情况，我们还将ICG溶液注入子宫颈。在术中和术后对纳入病例进行评估。将具有MB荧光的组(组A)与不具有MB荧光的对照组(组B)进行比较。
■共有25名患者（A组）在手术过程中接受了MB，清晰地展示了45条输尿管，成像成功率达90%。在输尿管肾积水的情况下，可以实现连续且更清晰的荧光成像。在大多数患者中，静脉输注MB后15-20分钟可见输尿管荧光，64%的患者在手术结束时仍表现出荧光。在同时患有ICG和MB的患者中，清晰地实现了双荧光成像。在包括的案件中，没有医源性输尿管损伤(0%)，我们观察到低于未接受MB的患者（1.3％）。两组的不良事件发生率相似。
■使用MB荧光是在妇科手术期间可视化输尿管的有效且安全的方法，并且可以减少医源性输尿管损伤，而不会增加相关的不良事件。为临床应用提供了广阔的前景。
■这项研究包括接受妇科腹腔镜手术的患者，同一位外科医生进行所有病例。在每次手术的早期阶段，快速静脉输注MB.对于需要SLN成像的情况，我们还将ICG溶液注入子宫颈。在术中和术后对纳入病例进行评估。将具有MB荧光的组(组A)与不具有MB荧光的对照组(组B)进行比较。
■共有25名患者（A组）在手术过程中接受了MB，清晰地展示了45条输尿管，成像成功率达90%。在输尿管肾积水的情况下，可以实现连续且更清晰的荧光成像。在大多数患者中，静脉输注MB后15-20分钟可见输尿管荧光，64%的患者在手术结束时仍表现出荧光。在同时患有ICG和MB的患者中，清晰地实现了双荧光成像。在包括的案件中，没有医源性输尿管损伤(0%)，我们观察到低于未接受MB的患者（1.3％）。两组的不良事件发生率相似。
■使用MB荧光是在妇科手术期间可视化输尿管的有效且安全的方法，并且可以减少医源性输尿管损伤，而不会增加相关的不良事件。为临床应用提供了广阔的前景。
