Studies on Liver Structur in Cholelithiasis:Clinical and Histopathologic Investigation, Particularly relating to the electron microscopic observation of biopsy materials

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• The author studied the stractural changes of liver in case of cholelithiasis, undertaken as a part of the serial researches performed in the laboratory under the guidance of Prof. Matsukura, histopathologically mainly, based upon the electron microscopic observations of biopsy materials available from 103 patients, namely 41 cases of cholecystolithiasis, 12 cases of choledocholithiasis, 6 cases of cholecysto-choledocholithiasis, 7cases of cholecystitis without stones, 7 caces of neoplasma of bile ducts, 14 cases of gastroduodenal ulcer, 11 cases of gastric cancer and 10 cases of postoprative serum hepatitis. The relations between the findings and the results of the test of the liver function were also studied.<BR>1) Nuclei of liver cells<BR>In regenerative process of liver seen in such cases as neoplasma of bile ducts, choledocholithiasis or hepatitis in which highly progressed and acute functional disturbances occur, invagination of nucleic membrane and appearance of the polynuclear cells were observed.<BR>2) Mitochondria<BR>No specific, slgnificant change was observed in each group of diseases but with more intensified jaundice the decrease of the number of the mitochondria and the dilatation were more frequently seen.<BR>3) Endoplasmic reticulum<BR>In cases of cholecystitis without stones or of hepatitis, disintegration of endoplasmic reticulum was appeared in high percentage and in such cases as in groups of cholelithiasis or choledocholithiasis in which pathologic changes occur in the cnmmon bile duct, the enlargement of the endoplasmic reticulum or the decrease of the granules was conspicuously observed.<BR>4) Inclusion of liver cells<BR>Around the nuclei of liver cell or bile canaliculi, lipid-like inclusion with highelctron density was observed every kind of the liver diseases.<BR>5) Bile canaliculus<BR>Enlargement of the bile canaliculi and microvilli were observed in such cases with extrahepatogenic obstructive mechanism but even in such cases as cholelithiasis or cholecystitis without any obstructive mechanism some of them showed the enlargement of the canaliculi. The communication of the canaliculi with Disse's lumen was seen only in several cases with manifestation of severe jaundice.<BR>6) Sinusoid<BR>Few cases showed the conspicous changes of the sinusoid but there were several cases in which fibrils increased.<BR>7) According to the findings of biopsies available from the patients who showed functional disturbances of liver even after 4 months from the operative correction of the obstructive jaundice or from the patients who showed no disturbance of liver function at the time of 6 months, one year and three years postoperatively, of which diseases were of bile ducts, particularly cholelithiasis-, there were some changes of the bile canaliculi and of mitcondria, namely, so called "intrahepatic cholestasis". These finding let us feel the necessity of the longterm postoperative follow-up of these patients.<BR>8) The morphologic changes of liver structure, particularly of mitochondria and the endoplasmic reticulum showed some relation with the results of the liver function tests such as B. S. P, GOT, GPT, A/G and etc. Also some correlation between the excretory functional test with I<SUP>131</SUP> Rose Bengal and the morphologic changes was assured.

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財団法人 日本消化器病学会 | 論文

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