Department of Veterinary Surgery, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, South Korea.
Department of Veterinary Surgery, Heamaru Referral Hospital, Seongnam, Korea.
PLoS One. 2024 May 22;19(5):e0300395. doi: 10.1371/journal.pone.0300395. eCollection 2024.
Cholecystectomy is indicated for gallbladder mucoceles (GBM). Evaluating the patency of the biliary duct and precise biliary tree visualization is crucial for reducing the risk of compromised bile flow after surgery. Therefore, intraoperative cholangiography (IOC) is recommended during cholecystectomy to prevent biliary tract injury. Although indocyanine green (ICG) cholangiography has been extensively reported in human medicine, only one study has been conducted in veterinary medicine. Therefore, this study aimed to demonstrate the use of ICG for IOC to identify fluorescent biliary tract images and determine the patency of the common bile duct during cholecystectomy in dogs. This study comprised 27 dogs, consisting of 17 with gallbladder mucoceles (GBM) and 10 controls, specifically including dogs that had undergone elective cholecystectomy for GBM. ICG injection (0.25 mg/kg) was administered intravenously at least 45 minutes before surgery. During the operation, fluorescent images from cholangiography were displayed on the monitor and obtained in black-and-white mode for the comparison of fluorescence intensity (FI). The FI values of the gallbladders (GBs) and common bile duct (CBD) were measured using FI analyzing software (MGViewer V1.1.1, MetapleBio Inc.). The results demonstrated successful CBD patency identification in all cases. Mobile GBM showed partial gallbladder visibility, whereas immobile GBM showed limited visibility. Additionally, insights into the adequate visualization of the remaining extrahepatic biliary tree anatomy were provided, extending beyond the assessment of CBD patency and gallbladder intensity. Our study demonstrates the potential of fluorescent IOC using intravenous injection of ICG for assessing the patency of the cystic duct and common bile duct during cholecystectomy in patients with GBM, eliminating the need for surgical catheterization and flushing of the biliary ducts. Further research is warranted to investigate and validate the broader applicability of ICG cholangiography in veterinary medicine.
胆囊切除术适用于胆囊黏液囊肿（GBM）。评估胆管通畅性和准确的胆道可视化对于降低术后胆汁流动受损的风险至关重要。因此，在胆囊切除术中建议进行术中胆管造影（IOC）以防止胆道损伤。尽管人医中已广泛报道了吲哚菁绿（ICG）胆管造影，但兽医中仅进行了一项研究。因此，本研究旨在展示使用 ICG 进行 IOC 以识别荧光胆道图像，并确定犬胆囊切除术中胆总管的通畅性。本研究包括 27 只狗，其中 17 只为胆囊黏液囊肿（GBM），10 只为对照，具体包括因 GBM 而接受择期胆囊切除术的狗。ICG 注射（0.25mg/kg）于术前至少 45 分钟静脉内给药。在手术过程中，胆管造影的荧光图像显示在监视器上，并以黑白模式获取以比较荧光强度（FI）。使用 FI 分析软件（MGViewer V1.1.1，MetapleBio Inc.）测量胆囊（GB）和胆总管（CBD）的 FI 值。结果表明，所有病例均成功识别了 CBD 的通畅性。可移动的 GBM 显示部分胆囊可见，而不可移动的 GBM 显示有限的可见性。此外，还提供了对剩余肝外胆道解剖结构的充分可视化的见解，超出了对 CBD 通畅性和胆囊强度的评估。我们的研究表明，静脉注射 ICG 进行荧光 IOC 具有评估 GBM 患者胆囊切除术时胆囊管和胆总管通畅性的潜力，无需进行胆管导管插入术和冲洗。需要进一步研究以调查和验证 ICG 胆管造影在兽医中的更广泛适用性。
