胆石疾患における胆道炎の内視鏡的分類とその病理組織学的検討

抄録

Choledochoscopic examination on the choledochitis was performed on 206 patients with the cholecystolithtasis and choledocholithiasis. Also common bile duct biopsies were obtained in 56 patients. Choledochitis was endoscopically divided into following four Grades; I non, II slight, III moderate and IV intense, respectively. In cholecystolithiasis 12.7 per cent of patients showed Grade II and III, whereas in choledocholithiasis 61.2 per cent of patients were categorized as Grade II-IV. There were erosions, mucous degeneration and stratified proliferation in the epithelia of 27.6 per cent of patients with cholecystolithiasis and 63 per cent with choledocholithiasis. Assuming that the choledochitis is confined to the infiltration of both lymphocytes and plasma cells or neutrophils in the epithelium, 10.3 per cent of patients with cholecystolithiasis and 37.0 per cent with choledocholithiasis exhibit such inflammatory cellular changes. These changes were more frequently observed in the deeper layer of the tunica muscularis in patients with choledocholithiasis (77.3 per cent) than in those with cholecystolithiasis (26.7 per cent). Subepithelial hyperplasia of the connective tissue in patients with choledocholithiasis and cholecystolithisis was seen in 70.4 and 27.6 per cent each. Hypetrophy or atrophy of the muscular fibers in the choledochal wall were more prominent in patients with choledocholithiasis (40.7 per cent) than in those with cholecystolithiasis (17.2 per cent). In summary, patients with choledocholithiasis are much more characterized by prominent erosions, mucous degeneration and stratified proliferation of choledochal epithelia than those with cholecystoliasis. Extension of inflammatory cells in the choledochal wall are more dominant in patients with choledocholithiasis than those observed in cholecystolithiasis. Subepithelial hyperplasia of the connective tissue and hypertrophy or atrophy of muscular fibers in the choledochal wall had the same tendency. Comparing both the endoscopic grade of the choledochitis with the histological inflammatory changes in the choledochal wall, there appeared a high correlation in patients with choledocholithiasis.