Laparoscopic indocyanine green fluorescence imaging technique in rare type II cystic biliary atresia.

Photodiagnosis and photodynamic therapy Pub Date : 2023-12-01 Epub Date: 2023-10-12 DOI:10.1016/j.pdpdt.2023.103846
Murong Wang, Junmin Liao, Shuangshuang Li, Shouhua Zhang, Jinshi Huang
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Abstract

In recent years, it has been reported that indocyanine green can be used for intraoperative navigation in Kasai surgery. However, there are no reports of its application in surgery for rare type II cystic biliary atresia. We report a girl presented with jaundice and light-colored stools. Laboratory tests showed impaired liver function with elevated serum bilirubin and bile acid levels. The abdominal ultrasound and MRCP suggested a common hepatic duct cyst. A diagnosis of choledochal cyst was suspected and biliary atresia could not be excluded. Conservative treatment was unsatisfactory. Laparoscopic exploration with indocyanine green fluorescence was performed on the 38th day of her life, and intraoperative diagnosis of type II CBA was made because the common hepatic duct cyst and its downstream anatomical structures did not show fluorescence. The postoperative bilirubin and bile acid levels decreased significantly and she was discharged two weeks after surgery. This result suggests that indocyanine green can be safely used in laparoscopic surgery for type II CBA, which not only helps in the differential diagnosis of CBA and choledochal cyst, but also confirms bile flow in real time.

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腹腔镜吲哚菁绿荧光成像技术在罕见的II型囊性胆道闭锁中的应用。
近年来,有报道称吲哚菁绿可用于Kasai手术的术中导航。然而,目前还没有报道其在罕见的II型囊性胆道闭锁手术中的应用。我们报告一名女孩出现黄疸和浅色大便。实验室检查显示肝功能受损,血清胆红素和胆汁酸水平升高。腹部超声和MRCP提示一个常见的肝管囊肿。怀疑诊断为胆总管囊肿,不能排除胆道闭锁。保守治疗并不令人满意。在她生命的第38天进行了吲哚菁绿荧光腹腔镜探查,由于肝总管囊肿及其下游解剖结构没有显示荧光,因此在术中诊断为II型CBA。术后胆红素和胆汁酸水平显著下降,术后两周出院。这一结果表明,吲哚菁绿可以安全地用于腹腔镜II型CBA手术,这不仅有助于CBA和胆总管囊肿的鉴别诊断,而且可以实时确认胆汁流量。
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