胆道閉鎖痛における肝内胆管の病理組織学的研究 : 特に術後胆汁流出に関連して

抄録

Histopathological study of the intrahepatic bile ducts (IHBD) was performed, using the wedge liver biopsy taken at hepatic portoenterostomy in 60 patients of biliary atresia. First, total area of all intrahepatic bile ductuli (B), and total area of all fibrotic area (F) in one field were measured by image processing system. B/F ratio was lower in patients with good postoperative bile flow (≧100ml/day), compared to patients with poor bile flow (<100ml/day), (p<0.05). B/F ratio became higher in patients with mild fibrosis (p<O.05). Secondly, patients were divided into three groups, according to the degree of degenerative changes of IHBDs. In group I (13 cases), degenerative change was minimal and no bile plug was identified. In group II (27 cases), degeneration was moderate and bile plugs were found in less than 10% of the total bile ducts. In group III (20 cases), degeneration was severe, and bile plugs were found in more than 10% of the total bile ducts. Degenerative change of the IHBDs shows parallel correlation to the age at operation (p<0.01) and the degree of liver fibrosis (p<0.05). Whereas, grading of degenerative changes of the IHBDs shows no correlation to the diameters of extrahepatic bile ducts at the porta hepatis. The present study suggested that the degenerative change of IHBDs is one of the most important factors, concerning the prognosis in biliary atresia patients.