肝外閉塞性黄疸肝の組織学的研究, とくに線維化の問題を中心として
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There has been no agreement in opinions as to whether the fibrogenetic process in the liver with extrahepatic obstructive jaundice starts from the portal triads or the pericentral areas of hepatic lobules. In order to study the fibrogenesis of biliary cirrhosis, histological studies were carried out on liver specimens obtained by needle biopsy, laparotomy or autopsy in 46 cases (calculosis of the bile duct, 11; carcinoma of the head of the pancreas, 10; carcinoma of the bile duct, 17 and miscellaneous, 8).Among these 46 cases, no fibrotic change was revealed in 16 (34.8%), slight fibrosis in 12 (26.1%), considerable degree of fibrosis in 13 (28.3%) and definite pictures of biliary cirrhosis in 5 (10.9%), respectively. Mean durations of jaundice due to the extrahepatic obstruction in each group was 40.3±9.3, 87.2±33.2, 181.2±44.2 and 873.6 days, respectively. There were no relations between the degree or site of obstruction in the bile duct and the degree of fibrosis of the liver. Histological observation revealed that the degree of fibrosis of the liver correlated with the degree of bile ductular proliferation, but did not correlate with the degree of parenchymal necrosis, bile stasis or proliferation of inflammatory cells.Concerning the fibrogenesis of the liver in extrahepatic obstructive jaundice, fibrosis began mainly from the periportal areas, and in a few cases it began from the centrolobular areas. In some cases, the two patterns of fibrosis coexisted more or less intermingling with other. At the early stage of obstruction, slight fibrosis of the liver was predominantly found in the portal and perihepatocellular areas. As the fibrosis progressed, periductular fibrosis became prominent.Serial microscopic examination of the liver specimens revealed that fibrous bands originated from the periportal and/or intralobular areas accompanying with marked bile ductular proliferation mainly connected with the fibrous bands in the neighboring portal triads. And partly, they also connected with the small fibrotic strings around central veins caused by parenchymal degeneration. It was assumed that these connections of the fibrous bands might gradually divide hepatic lobules into small pseudolobules.