Department of Surgery, Japanese Red Cross Society Himeji Hospital, 1-12-1 Shimoteno, Himeji, Hyogo 670-8540, Japan.
J Hepatobiliary Pancreat Sci. 2010 Mar;17(2):147-51. doi: 10.1007/s00534-009-0111-9. Epub 2009 May 14.
BACKGROUND/PURPOSE: The cholecystic veins are thought to be an important metastatic route of gallbladder carcinoma to the liver. In the present study we evaluated the cholecystic venous drainage area, utilizing a novel method, indocyanine green (ICG) fluorescence angiography after superselective catheterization of the cholecystic artery, to detect and elucidate cholecystic venous flow.
Cannulation of the cholecystic artery was performed under laparotomy in nine patients who required a cholecystectomy. After ICG injection into the cholecystic artery, the cholecystic venous flow images were visualized with a near-infrared camera system and were analyzed according to site, shape, and time of fluorescence.
Fluorescence images of the cholecystic venous flow could be viewed as real-time images in all patients. We demonstrated that the route of the cholecystic venous flow could be classified into two patterns: type 1, in which the cholecystic veins flowed directly into the hepatic parenchyma adjacent to the gallbladder; and type 2, in which the veins flowed into sites separate from the gallbladder. In the type 1 pattern, fluorescence was observed in segment (S; defined according to Couinaud's nomenclature) 4a or S5 adjacent to the gallbladder in all cases. On the other hand, in the type-2 pattern, fluorescence was observed in S4a (6/9), S5 (8/9), S4b (2/9), S3 (2/9), S1 (1/9), S2 (1/9), and S8 (1/9) distant from the gallbladder. Overall, two-thirds of the cases showed fluorescence in segments other than S4a or S5.
Indocyanine green (ICG) fluorescence angiography is considered to be a useful method to detect and elucidate cholecystic venous flow in real time. This study showed that the cholecystic venous flow spread to the liver through two different pathways, one that flowed directly into the hepatic parenchyma adjacent to the gallbladder, while the other flowed into sites separate from the gallbladder. Taking these findings into consideration, we may therefore need to reconsider the preventive effects of a hepatic resection.
背景/目的：胆囊静脉被认为是胆囊癌向肝脏转移的重要途径。本研究采用经胆囊动脉超选择性插管后吲哚菁绿（ICG）荧光血管造影的新方法，评估胆囊静脉引流区，以检测和阐明胆囊静脉血流。
在 9 例需要行胆囊切除术的患者中，在剖腹手术下进行胆囊动脉插管。在向胆囊动脉注射 ICG 后，使用近红外摄像系统观察胆囊静脉血流图像，并根据荧光的部位、形状和时间进行分析。
所有患者均能实时观察到胆囊静脉血流的荧光图像。我们证明，胆囊静脉血流的途径可分为两种类型：1 型，胆囊静脉直接流入紧邻胆囊的肝实质；2 型，静脉流入远离胆囊的部位。在 1 型中，所有病例均观察到胆囊旁 S4a 或 S5 段的荧光。另一方面，在 2 型中，在远离胆囊的 S4a（6/9）、S5（8/9）、S4b（2/9）、S3（2/9）、S1（1/9）、S2（1/9）和 S8（1/9）段观察到荧光。总的来说，三分之二的病例在 S4a 或 S5 以外的节段显示荧光。
吲哚菁绿（ICG）荧光血管造影被认为是实时检测和阐明胆囊静脉血流的一种有用方法。本研究表明，胆囊静脉血流通过两种不同的途径扩散到肝脏，一种是直接流入紧邻胆囊的肝实质，另一种是流入远离胆囊的部位。考虑到这些发现，我们可能需要重新考虑肝切除术的预防效果。
