Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan.
J Hepatobiliary Pancreat Sci. 2021 Jun;28(6):508-514. doi: 10.1002/jhbp.937. Epub 2021 Apr 6.
We re-analyzed data on cholangio-venous reflux from a clinical study conducted prospectively on 22 patients in 1974.
Direct cholangiography was performed with indocyanine green (ICG) mixed into Urographin under monitoring of intrabiliary pressure, and the participants were allocated to three groups according to whether ICG leakage into the blood, signs of infection, or both, were present.
The intrabiliary pressure of six patients negative for both ICG leakage and signs of infection was approximately 19.5 (median, [range 18-22]) cmH O. In contrast, for the five patients positive for ICG leakage but negative for signs of infection, the intrabiliary pressure was higher (median 32.0 [range 27-41) cmH O]. The 11 patients positive for both ICG leakage and signs of infection had the highest intrabiliary pressure (median 48.0 [range 33-77] cmH O). Our analyses revealed that, as the intrabiliary pressure increased, the status of ICG leakage and signs of infection appeared in a stepwise fashion.
Our findings suggest that the tight junctions sealing the bile canaliculi deteriorated with increasing intrabiliary pressure, resulting in reflux of the biliary contents into the vascular system via paracellular pathways between hepatocytes.
我们重新分析了 1974 年对 22 例患者进行前瞻性临床研究中获得的胆-静脉反流数据。
在监测胆道内压的情况下，将靛氰绿（ICG）混入泛影葡胺中进行直接胆管造影，并根据 ICG 是否漏入血液、是否存在感染迹象或两者兼而有之分三组。
两组均无 ICG 渗漏和感染迹象的六名患者的胆道内压约为 19.5（中位数，[范围 18-22]）cmH2O。相比之下，五名 ICG 渗漏但无感染迹象的患者胆道内压更高（中位数 32.0 [范围 27-41] cmH2O）。11 名 ICG 渗漏和感染迹象均为阳性的患者胆道内压最高（中位数 48.0 [范围 33-77] cmH2O）。我们的分析表明，随着胆道内压的升高，ICG 渗漏和感染迹象呈逐步出现。
我们的发现表明，胆管小管的紧密连接随着胆道内压的升高而恶化，导致胆汁内容物通过肝细胞之间的细胞旁途径反流到血管系统。
